Modified Frailty Index and Postoperative Outcomes of Zygomaticomaxillary Complex Fracture Repair
Ariana Shaari, David Herz, Om Tripathi, Disha Patil, Diana Shaari, George Bebawy, Adam Daniels, Steven OvadiaABSTRACT
Objective
The modified 5‐item frailty index (mFI‐5) is a comorbidity‐based risk stratification tool previously validated in patients undergoing facial plastic and reconstructive surgery. This retrospective US hospital database study investigates the association between mFI‐5 score and postoperative complications following zygomaticomaxillary complex (ZMC) fracture repair.
Methods
The National Surgical Quality Improvement Program was queried for patients undergoing ZMC fracture repair between 2005 and 2020. The mFI‐5 score was calculated by assigning one point for each of the following comorbidities: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent functional status. Patients were stratified by mFI‐5 score. Univariate and multivariable analyses were performed to assess associations between frailty and postoperative complications.
Results
A total of 2260 patients were included and stratified by mFI‐5 scores of 0 ( n = 1890), 1 ( n = 285), and 2 or greater ( n = 85). Higher mFI‐5 scores were associated with male sex, older age, higher American Society of Anesthesiologists classification, inpatient status, obesity, weight loss, bleeding disorders, and dependent functional status. Higher mFI‐5 was associated with increased rates of surgical complications, urinary tract infections, prolonged ventilation over 48 h, pneumonia, cumulative morbidity, and cumulative medical complications. On multivariable analysis, mFI‐5 scores of 1 ( p = 0.027) and 2 or greater ( p = 0.049) were independently associated with cumulative morbidity, and a score of 1 was associated with surgical complications ( p = 0.022).
Conclusion
The mFI‐5 is associated with cumulative morbidity and surgical complications following ZMC fracture repair. Assessment of frailty may improve perioperative risk stratification in this population.
Level of Evidence
4.