From the Division of Plastic Surgery, University of Utah; and Department of Population Health Sciences, University of Utah School of Medicine.
Plast Reconstr Surg. 2022 Jan 1;149(1):41-47. doi: 10.1097/PRS.0000000000008634.
The modified five-item frailty index is a validated and effective tool for assessing risk in surgical candidates. The authors sought to compare the predictive ability of the modified five-item frailty index to established risk factors for complications in free flap breast reconstruction.
The 2012 to 2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for free flap breast reconstructive procedures. Univariate and multivariate regression analysis models were used to assess how modified five-item frailty index and factors commonly used to risk stratify (age, body mass index, American Society of Anesthesiologists classification, and history of smoking) were associated with complications.
Of the total 10,550 cases, 24.1 percent experienced complications. A high modified five-item frailty index score is associated with a higher overall rate of postoperative complications (p < 0.001). This significant trend was demonstrated in both surgical (p < 0.001) and medical (p < 0.001) complications. When controlling for other risk factors commonly used for risk stratification such as age, body mass index, American Society of Anesthesiologists classification, and history of smoking, the modified five-item frailty index was significantly associated with medical (OR, 1.75; 95 percent CI, 1.37 to 2.22; p = 0.001) and any complications (OR, 1.58; 95 percent CI, 1.29 to 1.93; p < 0.001) and had the largest effect size. Assessing for specific complications, the modified five-item frailty index is the strongest independent predictor of reoperation (OR, 1.41; 95 percent CI, 1.08 to 1.81; p = 0.009).
The modified five-item frailty index is a useful predictor of postoperative outcomes in patients undergoing free flap breast reconstruction when compared to other historically considered risk factors for surgical complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
改良的五项目衰弱指数是一种经过验证且有效的工具，可用于评估手术患者的风险。作者旨在比较改良的五项目衰弱指数与既定的游离皮瓣乳房重建并发症风险因素的预测能力。
作者在美国外科医师学会国家外科质量改进计划数据库中查询了 2012 年至 2018 年的游离皮瓣乳房重建手术。采用单变量和多变量回归分析模型来评估改良的五项目衰弱指数和常用于风险分层的因素（年龄、体重指数、美国麻醉师协会分类和吸烟史）与并发症之间的关联。
在总共 10550 例病例中，24.1%的患者发生了并发症。较高的改良五项目衰弱指数评分与术后总体并发症发生率较高相关（p<0.001）。这一显著趋势在手术（p<0.001）和医疗（p<0.001）并发症中均有体现。在控制年龄、体重指数、美国麻醉师协会分类和吸烟史等常用于风险分层的其他风险因素后，改良的五项目衰弱指数与医疗（OR，1.75；95%置信区间，1.37 至 2.22；p=0.001）和任何并发症（OR，1.58；95%置信区间，1.29 至 1.93；p<0.001）显著相关，且效应量最大。评估特定并发症时，改良的五项目衰弱指数是再次手术的最强独立预测因素（OR，1.41；95%置信区间，1.08 至 1.81；p=0.009）。
与其他常用于手术并发症风险的历史因素相比，改良的五项目衰弱指数是游离皮瓣乳房重建患者术后结局的有用预测指标。
临床问题/证据水平：风险，III 级。
