Association Of The Modified Frailty Index (mfi-5) With Postoperative Complications After Panniculectomy
Jasmine Lee, BA1; Allyson R. Alfonso, BS, BA1; Rami S. Kantar, MD, MPH2; Gustave K. Diep, MD1; Zoe P. Berman, MD1; Elie P. Ramly, MD1; David A. Daar, MD, MBA1; Jamie P. Levine MD1; Daniel J. Ceradini, MD1
1New York University Langone Health, New York, NY, USA; 2The University of Maryland Medical System/Shock Trauma Center, Baltimore, Maryland, USA
Purpose: Due to the high complication rate of panniculectomies, preoperative risk stratification is imperative. This study aimed to assess the predictive value of the 5-item modified frailty index (mFI-5) for postoperative complications following panniculectomy.
Methods: We performed a retrospective review of the ACS-NSQIP database for panniculectomy patients (2010-2015). The mFI-5 score (a composite of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functional status) was calculated utilizing a cut-off score of 2. Multivariate logistic and linear regression analysis was used to evaluate outcomes.
Results: A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421, 73.2%) had significantly higher BMIs (39.8±10.8 vs. 32.1±8.3; p<0.001), rates of wound complications (19.5% vs. 12.8%; p=0.03), overall complications (33.8% vs. 19.5%; p<0.001), and significantly longer hospital length of stay (3.6±5.0 vs. 1.9±3.0 days; p<0.001). MFI-5 score of 2 or more was an independent risk factor for wound complications (OR=1.26; 95% CI: 1.08-2.20; p=0.04) and overall complications (OR=1.34; 95% CI: 1.09-2.15; p=0.02). BMI was an independent risk factor for overall complications (OR=1.05; 95% CI: 1.02-1.08; p<0.001), wound complications (OR=1.05; 95% CI: 1.02-1.08; p<0.001), and longer hospital LOS (β=0.15; 95% CI: 0.11-0.18; p<0.001).
Conclusion: The rising rate of obesity and bariatric surgery has led to an increasing numbers of medically complex patients requesting panniculectomies. Frailty, as measured by the mFI-5, holds predictive value regarding outcomes of overall and wound complications after panniculectomy. The mFI-5 can be used preoperatively to identify high risk patients.
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