From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia.
Department of Biostatistics and Research, Prisma Health, Greenville.
Ann Plast Surg. 2022 Jun 1;88(5 Suppl 5):S485-S489. doi: 10.1097/SAP.0000000000003125. Epub 2022 Feb 18.
Microsurgical reconstruction is an integral part of plastic surgery. The 5-factor modified frailty index (5-mFI) is an effective tool to predict postoperative complications across multiple subspecialties. We aimed to determine if frailty scores using the 5-mFI can predict postoperative complications specifically in microvascular reconstruction.
Frailty scores were retrospectively assessed in microsurgical reconstruction patients (2012-2016) using the American College of Surgeons National Quality Improvement Program base. The 5 variables that comprise the 5-mFI are history of chronic obstructive pulmonary disease, history of congestive heart failure, functional status, hypertension requiring medication and diabetes. The data were analyzed using the Goodman test, χ2 test, and a logistic regression model. The congruence was also compared between the 5-mFI and the American Society of Anesthesiology (ASA) classification in predicting complications.
Of 5894 patients, the highest 5-mFI value was "3." Analyses show an increase in postoperative complications requiring ICU care. Further models indicate an association between readmission with hypertension and chronic obstructive pulmonary disease (P < 0.05). There was an increased risk of a failure to wean from ventilator with a history of chronic obstructive pulmonary disease and diabetes and an increased risk of readmission with a history of hypertension and chronic obstructive pulmonary disease. The 5-mFI and ASA were incongruent in predicting postoperative complications.
The 5-mFI predicts postoperative complications in the microsurgical reconstruction population. Although the 5-mFI and ASA predict different complications, their use provides insight into the potential adjustable risks before surgery.
显微重建是整形外科学的一个组成部分。5 因素改良衰弱指数（5-mFI）是一种有效的工具，可预测多个亚专科的术后并发症。我们旨在确定使用 5-mFI 的衰弱评分是否可以专门预测微血管重建中的术后并发症。
使用美国外科医师学会国家质量改进计划基础，回顾性评估了显微重建患者（2012-2016 年）的衰弱评分。5-mFI 包含的 5 个变量是慢性阻塞性肺疾病史、充血性心力衰竭史、功能状态、需要药物治疗的高血压和糖尿病。使用 Goodman 检验、χ2 检验和逻辑回归模型对数据进行分析。还比较了 5-mFI 与美国麻醉医师协会（ASA）分类在预测并发症方面的一致性。
在 5894 例患者中，最高的 5-mFI 值为“3”。分析显示术后需要 ICU 护理的并发症增加。进一步的模型表明，高血压和慢性阻塞性肺疾病（P<0.05）与再入院之间存在关联。慢性阻塞性肺疾病和糖尿病史与呼吸机脱机失败风险增加有关，而高血压和慢性阻塞性肺疾病史与再入院风险增加有关。5-mFI 和 ASA 在预测术后并发症方面不一致。
5-mFI 预测了显微重建人群的术后并发症。尽管 5-mFI 和 ASA 预测了不同的并发症，但它们的使用提供了术前潜在可调节风险的见解。
