Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Am Surg. 2021 Sep;87(9):1420-1425. doi: 10.1177/0003134820952438. Epub 2020 Dec 30.
The modified frailty index (mFI-11) is a National Surgical Quality Improvement Program (NSQIP)-based 11-factor index that has been proven to adequately reflect frailty and predict mortality and morbidity. In the past years, certain NSQIP variables have been removed from the database; as of 2015, only 5 out of the original 11 factors remain. While the predictive power and usefulness of this 5-factor index (mFI-5) has been proven in previous work, it has yet to be studied in the geriatrics population. The goal of our study was to compare the mFI-5 to the mFI-11 in terms of value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission for patients aged 65 years and older.
Spearman's Rho was calculated to compare the value, and unadjusted and adjusted logistic regressions were created for three outcomes in nine surgical subspecialties. Correlation coefficients were above .86 across all surgical specialties except for cardiac surgery. Adjusted and unadjusted models showed similar C-statistics for mFI-5 and 11.
Overall predictive values of geriatric mFI-5 and mFI-11 were lower than those for the general population but still had effective predictive value for mortality and post-operative complications (C-Stat ≥ .7) and weak predictive value for 30-day readmission.
The mFI-5 is an equally effective predictor as the mFI-11 in all subspecialties and an effective predictor of mortality and postoperative complication in the geriatric population. This index has credibility for future use to study frailty within NSQIP, within other databases, and for clinical assessment and use.
改良衰弱指数（mFI-11）是一种基于国家外科质量改进计划（NSQIP）的 11 因素指数，已被证明能充分反映衰弱状况，并预测死亡率和发病率。在过去的几年中，某些 NSQIP 变量已从数据库中删除；截至 2015 年，只有 11 个原始因素中的 5 个仍然存在。虽然这 5 因素指数（mFI-5）的预测能力和实用性已在前一项研究中得到证实，但它尚未在老年人群中进行研究。我们的研究目的是比较 mFI-5 和 mFI-11 在预测 65 岁及以上患者死亡率、术后感染和非计划性 30 天再入院方面的价值和预测能力。
计算 Spearman's Rho 以比较价值，在九个外科亚专科中为三个结局创建未经调整和调整后的 logistic 回归。除心脏外科外，所有外科专业的相关系数均高于.86。调整和未调整模型显示 mFI-5 和 11 的调整后 C 统计量相似。
总体而言，老年 mFI-5 和 mFI-11 的预测值低于普通人群，但对死亡率和术后并发症仍具有有效的预测价值（C 统计量≥.7），对 30 天再入院的预测值较弱。
mFI-5 在所有亚专科中与 mFI-11 一样是一种有效的预测因子，也是老年人群中死亡率和术后并发症的有效预测因子。该指数在未来可用于 NSQIP 内、其他数据库内以及临床评估和应用中研究衰弱状况。
