Abstract
Background
Frailty syndrome is an established predictor of adverse outcomes after surgical procedures.
Our study aimed to compare the simplified National Surgical Quality Improvement Program
5-factor–modified frailty index (mFI-5) to its prior 11-factor–modified frailty index
(mFI-11) with respect to the predictive ability for mortality, postoperative complications,
and unplanned 30-d readmission in patients undergoing lower limb amputation.
Methods
The National Surgical Quality Improvement Program (2005-2012) databank was queried
for all geriatric patients (>65 y) who underwent above-knee and below-knee amputations.
We calculated each mFI by dividing the number of factors present for a patient by
the total number of available factors. To assess the correlation between the mFI-5
and mFI-11, we used Spearman's rho rank coefficient. We then compared the two indices
for each outcome (30-d complication, 30-d mortality, and 30-d readmission) and C-Statistic
using predictive models.
Results
A total of 8681 patients were included with mean age of 76 ± 9 y, complication rate
35.8%, mortality rate 10.2%, and readmission rate 15.9%. There was no difference in
type of amputation in frail and nonfrail. Correlation between the mFI-5 and mFI-11
was above 0.9 for all outcome measures. Both mFI-5 and mFI-11 indexes had strong predictive
ability for mortality, postoperative complications, and 30-d readmissions.
Conclusions
In patients undergoing major lower limb amputation, we found mFI-5 and the mFI-11
were equally effective in predicting postoperative outcomes. Frailty remained a strong
predictor of postoperative complications, mortality, and 30-d readmission.
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Article info
Publication history
Published online: March 08, 2021
Accepted:
December 16,
2020
Received in revised form:
November 25,
2020
Received:
April 28,
2020
Footnotes
Quick Shot Presentation at the Academic Surgical Congress Annual Meeting, February 2020, Orlando, Florida.
Author disclosure statement: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors’ contributions: V.P, T.T, K.K, W.Z and P.N designed this study. V.P, K.K, J.C, V.H, and H.K searched the literature. V.P, J.C, V.H, H.K, and W.J, collected the data. V.P, T.T, W.Z, and P.N analyzed the data. All authors participated in data interpretation and manuscript preparation.
Identification
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© 2020 Elsevier Inc. All rights reserved.
