Lee Jasmine, Alfonso Allyson R, Kantar Rami S, Diep Gustave K, Berman Zoe P, Ramly Elie P, Daar David A, Levine Jamie P, Ceradini Daniel J
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y.
The University of Maryland Medical System/Shock Trauma Center, Baltimore, Md.
Plast Reconstr Surg Glob Open. 2020 Jul 21;8(7):e2987. doi: 10.1097/GOX.0000000000002987. eCollection 2020 Jul.
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 in the elderly following panniculectomy.
A retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database for patients over the age of 65 years who underwent a panniculectomy between 2010 and 2015 was conducted. The mFI-5 score was calculated for each patient based on the presence of diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status, and an mFI-5 score of 2 was used as a cutoff. Multivariate logistic and linear regression analysis was used to determine the validity of the mFI-5 as a predictor of postoperative complications.
A total of 575 patients were analyzed. Patients with an mFI-5 score of 2 or more (421; 73.2%) had significantly higher rates of wound complications (19.5% versus 12.8%; = 0.03), overall complications (33.8% versus 19.5%; < 0.001), and significantly longer hospital length of stay (3.6±5.0 versus 1.9±3.0; < 0.001). mFI-5 score of 2 or more was an independent risk factor for wound complications (odds ratio, 1.26; 95% confidence interval, 1.08-2.20; = 0.04) and overall complications (odds ratio, 1.34; 95% confidence interval, 1.09-2.15; = 0.02).
Frailty, as measured by the mFI-5, holds a predictive value regarding outcomes of wound complications and overall complications in elderly patients after panniculectomy. The mFI-5 score can be used to identify high-risk patients before surgery.
由于腹壁成形术的并发症发生率较高，术前风险分层势在必行。本研究旨在评估5项改良虚弱指数（mFI-5）对老年患者腹壁成形术后并发症的预测价值。
对美国外科医师学会国家外科质量改进计划数据库进行回顾性队列研究，纳入2010年至2015年间接受腹壁成形术的65岁以上患者。根据糖尿病、高血压、充血性心力衰竭、慢性阻塞性肺疾病和依赖性功能状态计算每位患者的mFI-5评分，并将mFI-5评分为2作为临界值。采用多因素逻辑回归和线性回归分析来确定mFI-5作为术后并发症预测指标的有效性。
共分析了575例患者。mFI-5评分≥2分的患者（421例；73.2%）伤口并发症发生率（19.5%对12.8%；P = 0.03）、总体并发症发生率（33.8%对19.5%；P < 0.001）显著更高，住院时间显著更长（3.6±5.0天对1.9±3.0天；P < 0.001）。mFI-5评分≥2分是伤口并发症（比值比，1.26；95%置信区间，1.08 - 2.20；P = 0.04）和总体并发症（比值比，1.34；95%置信区间，1.09 - 2.15；P = 0.02）的独立危险因素。
以mFI-5衡量的虚弱状态对老年患者腹壁成形术后伤口并发症和总体并发症的结局具有预测价值。mFI-5评分可用于术前识别高危患者。
