From the Division of Plastic Surgery, University of Utah School of Medicine.
Department of Population Health Sciences, University of Utah School of Medicine.
Ann Plast Surg. 2022 Jul 1;89(1):23-27. doi: 10.1097/SAP.0000000000002771.
Preoperative risk assessment is essential in determining which surgical candidates will have the most to gain from an operation. The 5-item modified frailty index (mFI-5) has been validated as an effective way to determine this risk. This study sought to evaluate the performance of the mFI-5 as a predictor of postoperative complications after tissue expander placement.
Patients who underwent placement of a tissue expander were identified using the 2012 to 2018 American College of Surgeons National Surgical Quality Improvement Project database. Univariate and multivariate regression analysis models were used to assess how mFI-5, the components of the mFI-5 (functional status, diabetes, chronic obstructive pulmonary disease, chronic heart failure, and hypertension), and other factors commonly used to risk stratify (age, body mass index [BMI], American Society of Anesthesiologists (ASA) classification, and history of smoking) were associated with complications.
In 44,728 tissue expander placement cases, the overall complication rate was 10.5% (n = 4674). The mFI-5 score was significantly higher in the group that experienced complications (0.08 vs 0.06, P < 0.001). Compared with the mFI-5 individual components and other common variables used preoperatively to risk stratify patients, univariate analysis demonstrated that mFI-5 had the largest effect size (odds ratio [OR], 5.46; confidence interval [CI], 4.29-6.94; P < 0.001). After controlling for age, BMI, ASA classification, and history of smoking, the mFI-5 still remained the predictor of complications with the largest effect size (OR, 2.25; CI, 1.70-2.97; P < 0.001). In assessing specific complications, the mFI-5 is the independent predictor with the largest significant effect size for surgical dehiscence (OR, 12.76; CI, 5.58-28.18; P < 0.001), surgical site infection (OR, 6.68; CI, 4.53-9.78; P < 0.001), reoperation (OR, 5.23; CI, 3.90-6.99; P < 0.001), and readmission (OR, 4.59; CI, 3.25-6.45; P < 0.001) when compared with age, BMI, ASA class, and/or history of smoking alone.
The mFI-5 can be used as an effective preoperative predictor of postoperative complications in patients undergoing tissue expander placement. Not only does it have the largest effect size compared with other historical perioperative risk factors, it is more predictive than each of its individual components.
术前风险评估对于确定哪些手术患者将从手术中获益最大至关重要。5 项改良虚弱指数（mFI-5）已被验证为一种有效的确定这种风险的方法。本研究旨在评估 mFI-5 作为预测组织扩张器放置后术后并发症的指标的性能。
使用 2012 年至 2018 年美国外科医师学会国家手术质量改进计划数据库确定接受组织扩张器放置的患者。使用单变量和多变量回归分析模型评估 mFI-5、mFI-5 的组成部分（功能状态、糖尿病、慢性阻塞性肺疾病、慢性心力衰竭和高血压）以及其他常用于风险分层的因素（年龄、体重指数 [BMI]、美国麻醉医师协会 [ASA] 分类和吸烟史）与并发症的关系。
在 44728 例组织扩张器放置病例中，总体并发症发生率为 10.5%（n=4674）。经历并发症的组的 mFI-5 评分明显更高（0.08 与 0.06，P<0.001）。与术前用于风险分层的 mFI-5 个体组成部分和其他常见变量相比，单变量分析表明 mFI-5 的影响最大（优势比 [OR]，5.46；置信区间 [CI]，4.29-6.94；P<0.001）。在控制年龄、BMI、ASA 分类和吸烟史后，mFI-5 仍然是具有最大影响的并发症预测因子（OR，2.25；CI，1.70-2.97；P<0.001）。在评估特定并发症时，mFI-5 是手术裂开（OR，12.76；CI，5.58-28.18；P<0.001）、手术部位感染（OR，6.68；CI，4.53-9.78；P<0.001）、再次手术（OR，5.23；CI，3.90-6.99；P<0.001）和再入院（OR，4.59；CI，3.25-6.45；P<0.001）的独立预测因子，与年龄、BMI、ASA 分级和/或吸烟史单独相比，其具有最大的显著影响。
mFI-5 可作为预测组织扩张器放置患者术后并发症的有效术前指标。它不仅比其他历史围手术期危险因素具有更大的影响大小，而且比其各个组成部分更具预测性。
