Assessing Frailty in Plastic Surgery: Analysis of the Five-factor Index.

Frailty has been shown to have a strong association with adverse outcomes in several surgical specialties. Only recently, however, its relevance in plastic surgery has been examined, yielding inconsistent results. Our goal was to apply the five-factor modified frailty index (mFI-5) across multiple subcategories of plastic surgery procedures to identify potential areas where it might prove useful. NSQIP data from 2015 to 2019 were utilized. Plastic surgery CPT codes were placed into clinically relevant subcategories based on common procedure groupings as follows: superficial soft tissue procedures, head and neck reconstruction, hand surgery, breast reconstruction, gender surgery, esthetic surgery, and facial fractures. The mFI-5 score was calculated for each subcategory. C-statistics were used to determine predictive ability for 30-day morbidity. Multivariable logistic regressions were also calculated to assess for odds ratios (ORs) with regard to 30-day morbidity. A total of 188,741 patients fit inclusion criteria. The mean frailty of plastic surgery patients was noted to be lower than in other surgical specialties. C-statistic models and ORs showed mFI-5 to have predictive ability for post-operative complication in superficial soft tissue procedures (C stat: 0.758), hand surgery (C-stat: 0.832), breast reconstruction (C-statistic: 0.718), head and neck reconstruction (C-statistic: 0.735), and gender surgery (C-statistic: 0.732). The mFI-5 is a clinical tool that can be selectively and cautiously used in plastic surgery, for specific subcategories of procedures including soft tissue procedures, hand surgery, head and neck reconstruction, and breast reconstruction.