There is a scale called the Frailty Index to assess risk for patients as they get older. All 60 and 70 and 80 year olds are not equal in their surgical risk. So if you are doing a surgery, what is your risk?
This is a journal article out of the Aesthetic Surgery Journal August 2022, “Using the Modified Frailty Index to Predict Complications in Breast Reduction: A National Surgical Quality Improvement Study of 14,160 Cases.” In their discussion of why they did the study they said historical evaluation of your surgical risk- age, BMI, comorbidities like diabetes and high blood pressure- are not as accurate to predict complication rates.
Study: They looked at breast reduction only surgery (it couldn’t be combined with other procedures) in a retrospective review from 2013 to 2019. They looked at:
- Age
- BMI
- number of major cobmorbidities
- Anesthesia class
- smoking status
- diabetes
- steroid use
- and Modified Frailty Index score.
They looked at all cause 30 day complications, 30 day surgery site complications, length of stay. 14,160 patients were analyzed. The average age was 41.6, mean BMI was 31.4, most patients were white and Non Hispanic.
Findings?
- Overall complication rate was 5.6%
- The most common complication was superficial incisional surgery site infection followed by an unplanned return to the OR.
- The Modified Frailty Index score significantly predicted overall complications, surgery site complications, complication severity, overnight stay and likelihood of readmission.
My thoughts?
Pretty cool that this score statistically significantly predicted complications. I have blogged before about the frailty index. This modified index differs. It looks at 5 factors:
- Congestive heart failure within 30 days before surgery (1 point if yes)
- Hypertension requiring medication (1 point if yes)
- History of COPD (1 point if yes)
- Diabetes – noninsulin or insulin (1 point if yes)
- Dependent functional status – are they totally independent? (Do they get any help with their eating, mobility, driving, living etc) (1 point if yes)
They looked at if they scored zero, one, or greater than two. In the counterpoint discussion of the article, the commenter stated only 8 patients were in the congestive heart failure group (and rightfully said who would do elective surgery on a recent congestive heart failure patient?) and only 23 were in the dependent functional status group. They argue that BMI is a well known predictor of surgical site infections and was not included in this modified frailty index. Neither was smoking status. They also argue that diabetes should be stratified if insulin dependent or not.
So I like that this score correlated with issues. I do think for me it drives home how high blood pressure and diabetes are important factors. I do use the frailty index with my older patients. See blogs my blogs on the frailty index.