Chiarella Laetitia S, Huelsboemer Lioba, Diatta Fortunay, Klimitz Felix J, Kammien Alexander J, Kochen Alejandro, Boroumand Sam, Allam Omar, Kauke-Navarro Martin, Pomahac Bohdan
Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA.
Department of Plastic Surgery, University Hospital Muenster, Muenster, Germany.
Ann Surg Oncol. 2025 Jul;32(7):4829-4837. doi: 10.1245/s10434-025-17105-2. Epub 2025 May 8.
The 5-item modified Frailty Index (mFI-5) is a clinical tool to predict adverse outcomes in surgical patients by assessing five comorbidities: diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status. It helps to evaluate postoperative complication risks, recovery time, and overall survival, particularly in frail patients undergoing oncological and gynecological surgeries.
This retrospective cohort study analyzed American College of Surgeons, National Surgical Quality Improvement Program data from adult female patients undergoing mastectomy procedures without reconstruction between 2017 and 2022. Patients were selected based on Current-Procedural-Terminology codes, excluding incomplete or non-breast-related cases. Preoperative, perioperative, and 30-day postoperative data were analyzed using logistic and linear regression models, with the mFI-5 cutoff set at 2.
Between 2017 and 2022, 860 patients underwent mastectomies at Yale Healthcare Network; 19% (n = 163) had mFI score ≥2. High-risk patients (mFI ≥2) were significantly older (66.32 ± 10.83 years) and had a higher body mass index (33.69 ± 7.73, both p < 0.001). Surgical complications occurred in 11.98% of patients, with a higher rate in the high-risk group (22.7% vs. 9.5%, p < 0.001). Adjusted multivariate logistic regression showed an increased risk of complications in frail patients (aOR 2.66; [1.60-4.43], p < 0.001). Although slight reductions in hospital stay and surgery duration were observed for high-risk patients, these differences were not significant. Sensitivity analysis confirmed higher odds of complications, including acute kidney failure (odds ratio [OR] 9.01) and pneumonia (OR 4.10).
The mFI-5 is a robust tool for predicting surgical complications in patients undergoing mastectomy, particularly those with multiple comorbidities.
5项改良衰弱指数（mFI-5）是一种临床工具，通过评估5种合并症来预测手术患者的不良结局：糖尿病、高血压、充血性心力衰竭、慢性阻塞性肺疾病和依赖性功能状态。它有助于评估术后并发症风险、恢复时间和总体生存率，特别是在接受肿瘤和妇科手术的体弱患者中。
这项回顾性队列研究分析了美国外科医师学会国家外科质量改进计划中2017年至2022年间接受乳房切除术且未进行重建的成年女性患者的数据。根据当前手术操作术语编码选择患者，排除不完整或与乳房无关的病例。使用逻辑回归和线性回归模型分析术前、围手术期和术后30天的数据，mFI-5的临界值设定为2。
2017年至2022年间，耶鲁医疗网络有860例患者接受了乳房切除术；19%（n = 163）的mFI评分≥2。高危患者（mFI≥2）年龄显著更大（66.32±10.83岁），体重指数更高（33.69±7.73，均p < 0.001）。11.98%的患者发生了手术并发症，高危组的发生率更高（22.7%对9.5%，p < 0.001）。调整后的多变量逻辑回归显示体弱患者并发症风险增加（调整后比值比2.66；[1.60 - 4.43]，p < 0.001）。尽管高危患者的住院时间和手术时长略有缩短，但这些差异不显著。敏感性分析证实并发症的几率更高，包括急性肾衰竭（比值比[OR] 9.01）和肺炎（OR 4.10）。
mFI-5是预测接受乳房切除术患者手术并发症的有力工具，尤其是那些有多种合并症的患者。
