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.
Keywords: Abdominal wall reconstruction; Frailty; Morbidity; Mortality.