Modified Frailty Index Predicts Postoperative Outcomes in Patients Undergoing Radical Pelvic Surgery

Am Surg. 2020 Feb 1;86(2):95-103.


Patients undergoing radical pelvic surgery such as proctectomy or radical cystectomy are at risk of experiencing a variety of complications. Frailty renders patients vulnerable to adverse events. We hypothesize that frailty measured preoperatively using a validated scoring system correlates with increased likelihood of experiencing Clavien-Dindo grade IV complications and 30-day mortality and may be used as a predictive model for patients preoperatively. The NSQIP database was queried for patients who underwent proctectomy or radical cystectomy from 2008 to 2012. Preoperative frailty was calculated using the 11-point modified frailty index (MFI). Patients were scored based on the presence of indicators and categorized into two groups (<3 or ≥3). Major postoperative morbidities and mortality were identified and analyzed in each group. 10,048 proctectomy and cystectomy patients were identified. The MFI was found to be predictive of both 30-day mortality (P < 0.0001) and Clavien-Dindo grade IV complications (P < 0.0001). Receiver operating characteristic analysis demonstrated improved discriminative power of the MFI with the addition of American Society of Anesthesiologists class for both prediction of complications and 30-day mortality. An MFI score of ≥3 is predictive of postoperative morbidity and mortality. Providers should be encouraged to calculate frailty preoperatively to predict adverse outcomes.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Cystectomy / adverse effects*
  • Cystectomy / mortality
  • Cystectomy / statistics & numerical data
  • Databases, Factual
  • Female
  • Frailty / complications
  • Frailty / diagnosis*
  • Frailty / mortality
  • Humans
  • Male
  • Middle Aged
  • Pelvis / surgery
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Postoperative Period
  • Predictive Value of Tests
  • Proctectomy / adverse effects*
  • Proctectomy / mortality
  • Proctectomy / statistics & numerical data
  • ROC Curve
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult