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Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction

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Abstract

Purpose

Frailty is becoming an increasingly established risk factor for adverse postoperative outcomes. Given the innately high morbidity involved in complex abdominal wall reconstruction (CAWR) and the propensity for co-morbidities among this patient population, we sought to determine the predictive utility of a frailty index in patients undergoing CAWR.

Methods

A retrospective analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database. A total of 70,339 patients undergoing CAWR were identified using CPT codes for ventral hernia repair  ± components separation, ± placement of mesh. A Modified Frailty Index (mFI) was calculated for each patient. Outcomes included overall morbidity, Clavien–Dindo Grade IV (CDIV) complications, and mortality.

Results

Overall, 9931 patients had at least one complication associated with their procedure and an average calculated mFI of 0.12 (± 0.11) which was significantly greater than the average mFI noted in patients with no complications (0.077 ± 0.85, p <  0.001). Similarly, average mFI score (0.16  ±  0.12) in patients with CDIV complications (n = 2541) was once again significantly greater than those without CDIV complications (0.080  ±  0.09; p  <  0.001). Multivariable analyses also showed that all individual factors of the mFI were predictive of all-cause and CDIV complications (p  <  0.001). Higher pre-operative mFI conferred a 7.77×  likelihood of all-cause complications, 35.71×  likelihood of CDIV complications, 3.85×  likelihood of surgical site complications, and a 62.05×  likelihood of death (p  <  0.001 for all comparisons).

Conclusion

We have shown that frailty as measured by mFI is an accurate predictor of morbidity and mortality in patients undergoing CAWR.

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Funding

There was no internal or external financial support for this study.

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Authors and Affiliations

  1. Department of Plastic Surgery, University of Pittsburgh School of Medicine, 3550 Terrace Street, Scaife Hall, Suite 6B, Pittsburgh, PA, 15261, USA

    W. J. Joseph, M. E. Baron, I. Chow & E. H. Beers

  2. Division of Plastic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA

    N. G. Cuccolo

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  1. W. J. Joseph
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  2. N. G. Cuccolo
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  3. M. E. Baron
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  4. I. Chow
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Correspondence to W. J. Joseph.

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Conflict of interest

None of the authors have a financial interest in any of the products, devices, drugs, or procedures mentioned in this manuscript.

Ethical approval

The patient information in this study is de-identified and available to all institutions complying with the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Data Use Agreement.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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For this retrospective review, formal consent is not required.

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The ACS NSQIP databases are the source of information used in this study. Data extrapolated, statistical analysis performed, and conclusions reached have not been verified by the ACS NSQIP but rather are the result of the work done by the authors of this study.

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Joseph, W.J., Cuccolo, N.G., Baron, M.E. et al. Frailty predicts morbidity, complications, and mortality in patients undergoing complex abdominal wall reconstruction. Hernia 24, 235–243 (2020). https://doi.org/10.1007/s10029-019-02047-y

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