Akhavan Arya A, Liu Helen, Alerte Eric, Ibelli Taylor, Etigunta Suhas K, Katz Abigail, Kuruvilla Annet S, Taub Peter J
From the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital.
Icahn School of Medicine at Mount Sinai.
Plast Reconstr Surg. 2024 Apr 1;153(4):825-833. doi: 10.1097/PRS.0000000000010632. Epub 2023 May 9.
Although age, body mass index (BMI), and major comorbidities were historically used as predictors of surgical risk, recent literature supports patient frailty as a more accurate predictor. Database studies and chart reviews support the modified Charlson Comorbidity Index (mCCI) and the Modified Five-Item Frailty Index (mFI-5) as predictors of postsurgical complications in plastic surgery. The authors hypothesized that the mFI-5 and mCCI are more predictive of abdominoplasty complications than historic risk proxies.
A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database was performed for abdominoplasty patients from 2013 to 2019. Demographics, comorbidities, and complications were gathered. The mFI-5 and mCCI scores were calculated per patient. Age, BMI, major comorbidities, American Society of Anesthesiologists class, mFI-5 score, and mCCI score were compared as predictors of all-cause 30-day complications, 30-day surgical-site complications, length of stay, and aggregate Clavien-Dindo complication severity score.
Of 421 patients, the strongest predictors for all-cause complications and complication severity were mCCI score greater than or equal to 3 and mFI-5 score greater than or equal to 2. The mFI-5 score was the strongest predictor of unplanned reoperation. Length of stay was best predicted by age greater than or equal to 65. The only predictor of surgical-site complications was BMI greater than or equal to 30.0 kg/m 2 . Smoking was predictive of complication severity, but not any other outcome.
The mFI-5 and mCCI are stronger outcome predictors than historically used factors, which showed little predictive value in this cohort. Although the mCCI is a stronger predictor than the mFI-5, the mFI-5 is easily calculated during an initial consultation. Surgeons can apply these tools to aid in risk stratification for abdominoplasty.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
尽管年龄、体重指数（BMI）和主要合并症在历史上一直被用作手术风险的预测指标，但最近的文献支持患者虚弱是更准确的预测指标。数据库研究和图表回顾支持改良查尔森合并症指数（mCCI）和改良五项虚弱指数（mFI-5）作为整形手术术后并发症的预测指标。作者假设，与传统风险指标相比，mFI-5和mCCI对腹壁成形术并发症的预测性更强。
对美国外科医师学会国家外科质量改进计划数据库进行回顾性研究，纳入2013年至2019年接受腹壁成形术的患者。收集人口统计学、合并症和并发症数据。计算每位患者的mFI-5和mCCI评分。比较年龄、BMI、主要合并症、美国麻醉医师协会分级、mFI-5评分和mCCI评分作为全因30天并发症、30天手术部位并发症、住院时间和Clavien-Dindo并发症严重程度综合评分的预测指标。
在421例患者中，全因并发症和并发症严重程度的最强预测指标是mCCI评分大于或等于3以及mFI-5评分大于或等于2。mFI-5评分是计划外再次手术的最强预测指标。住院时间的最佳预测指标是年龄大于或等于65岁。手术部位并发症的唯一预测指标是BMI大于或等于30.0kg/m²。吸烟可预测并发症严重程度，但对其他结果无预测作用。
与传统使用的因素相比，mFI-5和mCCI是更强的结果预测指标，传统因素在该队列中显示出的预测价值很小。尽管mCCI比mFI-5的预测性更强，但mFI-5在初次会诊时易于计算。外科医生可以应用这些工具来辅助腹壁成形术的风险分层。
临床问题/证据级别：风险，III级
