Stead Thor S, Vishwanath Neel, Sobti Nikhil, Kheirbek Tareq, Kite Amy C
Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, New York City, USA.
The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Hand (N Y). 2025 Sep 18:15589447251366678. doi: 10.1177/15589447251366678.
Digit replantation has a significant risk of postoperative complications including an estimated reoperation rate around 14%. This study evaluates the modified frailty index 5 (mFI-5) in predicting postoperative complications including reoperation for digit replantation.
The American College of Surgeons' National Surgical Quality Improvement Program database (2007-2019) was queried to identify patients who underwent upper extremity blood vessel repair distal to the wrist. Demographics, patient characteristics, mFI-5 scores, and all complications, including reoperation and readmission, were analyzed using univariate and multivariate analyses to identify associations between mFI-5 and complications.
We identified 1336 patients who underwent digit replantation. Of those, 99 patients (7.4%) had mFI-5 ≥ 3. Frail patients were defined as having mFI-5 ≥ 3 based on prior literature. Higher mFI-5 scores correlated with increased rates of all-cause complications (mFI-5 ≥ 3: 51.5% vs mFI-5 = 0: 9.2%, < .001), readmission (mFI-5 ≥ 3: 15.8% vs mFI-5 = 0: 2.2%, < .001), and reoperation (mFI-5 ≥ 3: 8.8% vs mFI-5 = 0: 3.1%, < .001). Multivariate analysis indicated that an mFI-5 score ≥ 3 significantly increased the rates of any complication (odds ratio [OR] = 9.1, 95% confidence interval [CI], 3.9-21.2, < .001), mortality (OR = 5.4, 95% CI, 1.1-27.0, = .04), surgical complications (OR = 7.5, 95% CI, 2.5-22.9, < .001), and medical complications (OR = 13.4, 95% CI, 3.9-46.7, < .001). These patients also had lower odds of home discharge (OR = 0.35, 95% CI, 0.22-0.56, < .001) and higher odds of unplanned readmission (OR = 1.4, 95% CI, 1.3-1.5, < .001) compared with those with mFI-5 = 0.
The mFI-5 is an effective tool for predicting adverse outcomes in digit replantation. It is simple to calculate preoperatively and aids in risk stratification, perioperative counseling, operative planning, and postoperative outcomes.
断指再植术后有发生并发症的重大风险，据估计再次手术率约为14%。本研究评估改良脆弱指数5（mFI-5）在预测断指再植术后包括再次手术在内的并发症方面的作用。
查询美国外科医师学会国家外科质量改进计划数据库（2007 - 2019年），以确定接受腕部远端上肢血管修复的患者。使用单因素和多因素分析对人口统计学、患者特征、mFI-5评分以及所有并发症（包括再次手术和再次入院）进行分析，以确定mFI-5与并发症之间的关联。
我们确定了1336例接受断指再植的患者。其中，99例（7.4%）的mFI-5≥3。根据先前文献，将mFI-5≥3的患者定义为虚弱患者。mFI-5评分越高，全因并发症发生率越高（mFI-5≥3：51.5% vs mFI-5 = 0：9.2%，P <.001）、再次入院率越高（mFI-5≥3：15.8% vs mFI-5 = 0：2.2%，P <.001）以及再次手术率越高（mFI-5≥3：8.8% vs mFI-5 = 0：3.1%，P <.001）。多因素分析表明，mFI-5评分≥3显著增加了任何并发症的发生率（比值比[OR]=9.1，95%置信区间[CI]，3.9 - 21.2，P <.001）、死亡率（OR = 5.4，95% CI，1.1 - 27.0，P =.04）、手术并发症发生率（OR = 7.5，95% CI，2.5 - 22.9，P <.001）以及医疗并发症发生率（OR = 13.4，95% CI，3.9 - 46.7，P <.001）。与mFI-5 = 0的患者相比，这些患者出院回家的几率也更低（OR = 0.35，95% CI，0.22 - 0.56，P <.001），计划外再次入院的几率更高（OR = 1.4，95% CI，1.3 - 1.5，P <.001）。
mFI-5是预测断指再植不良结局的有效工具。它术前计算简单，有助于风险分层、围手术期咨询、手术规划和术后结局评估。
