The Five-Item Modified Frailty Index (mFI-5) Predicts Adverse Short-term Outcomes in Patients Undergoing Mastectomy: A Propensity Score-Matched Analysis of 252,054 Cases.

BACKGROUND

Frailty has emerged as a critical predictor of postoperative outcomes, particularly in older surgical patients. However, its role in mastectomy patients remains underexplored. This study evaluates the utility of the 5-item Modified Frailty Index (mFI-5) in predicting 30-day postoperative complications in mastectomy patients, aiming to improve risk stratification and inform clinical decision-making.

METHODS

A retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was conducted from 2008 to 2022. Patients were categorized into high-risk (mFI-5 ≥ 2) and low-risk (mFI-5 < 2) groups. Propensity score matching (PSM) was applied to create balanced cohorts and multivariate logistic regression was used to evaluate associations between frailty and postoperative outcomes.

RESULTS

Of the 252,054 adult female patients who underwent mastectomy, 1.2 % were identified as high-risk frail. High-risk patients were older (70 ± 9.9 vs. 60 ± 14 years, P < .001) and had a higher BMI (35 ± 9.1 vs. 29 ± 7.1 kg/m², P < .001) compared to low-risk patients. After PSM, high-risk patients had significantly higher odds of any complication (OR: 2.05, 95 % CI: 1.70-2.47, P < .001), surgical complications (OR: 1.70, 95 % CI: 1.38-2.10, P < .001), and medical complications (OR: 3.81, 95 % CI: 2.64-5.50, P < .001). Key complications included infections, bleeding requiring transfusion, and unplanned readmissions.

CONCLUSION

The mFI-5 effectively identifies mastectomy patients at higher risk of postoperative complications, including medical complications and unplanned reoperation or readmission, underscoring its value in preoperative risk stratification. Incorporating frailty assessments into clinical practice could enhance surgical decision-making, optimize resource allocation, and improve patient outcomes.