From the Division of Plastic, Reconstructive and Hand Surgery.
School of Graduate Studies.
Ann Plast Surg. 2021 Jun 1;86(6S Suppl 5):S615-S621. doi: 10.1097/SAP.0000000000002765.
Frailty can be quantified using an index score to effectively predict surgical outcomes and complications. The modified frailty index (mFI) score includes 5 patient-specific medical history comorbidities including diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease/pneumonia, and nonindependent functional status. The purpose of our study was to apply the 5-item mFI score to predict and minimize complications in patients undergoing breast reconstruction.
The National Surgical Quality Improvement Program was queried for all patients undergoing primary breast reconstruction from 2016 to 2018. Patients were divided based on timing of reconstruction and type of reconstruction: immediate or delayed, and implant based or autologous based. A validated modified fragility score was applied to all patients. Patients were stratified by mFI scores of 0 (no comorbidities), 1 (1 comorbidity), and 2+ (2 or more comorbidities). Patient demographics and 30-day complications rates were recorded.
A total of 22,700 patients were identified. There were 10,673 patients who underwent immediate breast reconstruction, and 12,027 patients who underwent delayed breast reconstruction. A total of 14,159 patients underwent implant-based, and 8541 underwent autologous-based reconstruction. A total of 16,627 patients had an mFI score of 0, 4923 had a mFI score of 1, and 1150 had a mFI score of 2+. Compared with patients with an mFI score of 0, patients with an mFI score of 2 or greater were more likely to develop a postoperative complication (7.2 vs 12.3; P < 0.0001). Patients undergoing immediate reconstruction were more likely to develop a postoperative complications for every mFI category. The most common complications were wound and hematologic related.
Patients with higher mFI scores are likely to have an increase in postoperative complications after breast reconstruction. Increasing body mass index increases postoperative complications independent of frailty index scores. Patients with increasing frailty index scores undergoing immediate breast reconstruction have a significantly higher risk of postoperative complications compared with delayed reconstruction.Patients with increasing frailty index scores undergoing autologous breast reconstruction have a significantly higher risk of postoperative complications compared with implant-based reconstruction. High frailty index scores are associated with a higher risk of postoperative complications, reoperation rates, and readmission rates. Patients with higher mFI scores may benefit from a delayed implant-based reconstruction.
衰弱可以通过指数评分来量化，以有效预测手术结果和并发症。改良衰弱指数（mFI）评分包括 5 项患者特定的病史合并症，包括糖尿病、充血性心力衰竭、高血压、慢性阻塞性肺疾病/肺炎和非独立的功能状态。我们的研究目的是应用 5 项 mFI 评分来预测和最小化接受乳房重建的患者的并发症。
从 2016 年至 2018 年，国家手术质量改进计划对所有接受原发性乳房重建的患者进行了查询。根据重建时间和重建类型将患者分为即刻或延迟、植入物和自体基础。对所有患者应用经过验证的改良脆弱性评分。根据 mFI 评分（无合并症 0 分，1 项合并症 1 分，2 项或更多合并症 2+分）对患者进行分层。记录患者的人口统计学和 30 天并发症发生率。
共确定了 22700 名患者。其中 10673 名患者接受了即刻乳房重建，12027 名患者接受了延迟乳房重建。14159 名患者接受了植入物基础重建，8541 名患者接受了自体基础重建。16627 名患者的 mFI 评分为 0，4923 名患者的 mFI 评分为 1，1150 名患者的 mFI 评分为 2+。与 mFI 评分为 0 的患者相比，mFI 评分为 2 或更高的患者更有可能发生术后并发症（7.2%比 12.3%；P<0.0001）。接受即刻重建的患者在每个 mFI 类别中更有可能发生术后并发症。最常见的并发症是伤口和血液相关。
mFI 评分较高的患者在接受乳房重建后发生术后并发症的可能性增加。体重指数增加会增加术后并发症，而与脆弱指数评分无关。接受即刻乳房重建的脆弱指数评分增加的患者发生术后并发症的风险显著高于延迟重建的患者。接受自体乳房重建的脆弱指数评分增加的患者发生术后并发症的风险显著高于植入物基础重建的患者。高脆弱指数评分与术后并发症、再次手术率和再入院率增加相关。mFI 评分较高的患者可能受益于延迟植入物基础重建。
