The modified 5-item frailty index (mFI-5) was effectively used to predict surgical site infections in breast implant augmentation surgery as well as overall 30-day complications, according to study results published in Journal of Cosmetic Surgery.
Breast augmentation is one of the top elective plastic surgery procedures in the United States. Although performed frequently, breast augmentations have the highest complication rate of all cosmetic procedures in the US. Complications may include implant rupture, capsular contracture, infection, rippling, seroma, hematoma, nerve injury, and implant malposition. To ensure better patient safety, researchers sought to determine the relationship between weakness and 30-day complications after breast augmentation procedures.
In a retrospective review, researchers extracted data from the National Surgical Quality Improvement Program (NSQIP) database between 2015 and 2019. The data included surgical outcomes, demographic data, and perioperative and postoperative patient information.
A total of 2478 patients were included in the study, with a mean (SD) age of 35.94 (11.34) years (range, 18–78 years) and a mean (SD) BMI of 23.39 (4.45). Of these, 71.83% were White and 70.38% were non-Hispanic.
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Given the feasibility of the mFI-5, this tool offers surgeons a rapid and robust assessment of frailty and predicts adverse outcomes during the preoperative assessment process.
The researchers found patient frailty status to be a significant predictor of overall 30-day complications and surgical site infections (SSIs). The overall complication rate within 30 days was 2.14%. The most common individual complications were unplanned return to surgery (27 cases, 1.09%), readmission within 30 days (14 cases, 0.56%), and superficial SSIs (8 cases, 0.32%). Patients in the frail group experienced a higher rate of SSIs than those in the non-frail group (Pi =.049). Similarly, the results of logistic regression analysis showed that the mFI-5 is a reliable predictor of SSIs, with frail patients being 4.24 times more likely to develop SSIs than non-frail patients (odds ratio [OR]4.24; 95% CI, 0.96-13.55; Pi =.026).
In its ability to predict breast augmentation complications, the mFI-5 was found to be superior to other predictors such as BMI, smoking status, diabetes comorbidity, steroid use, and ASA (American Society of Anesthesiologists) classification.
According to the multivariable logistic regression model, after the researchers controlled for other independent variables, the mFI-5 was found to have the highest predictive power for total 30-day complications (OR, 3.14; 95% CI, 0.86-12.36 ; Pi =.085). However, the mFI-5 did not reach statistical significance. However, the researchers note that these findings are still important when considering the small sample size of frail patients, given that most plastic surgeons do not operate on this population frequently. They noted, “Although there was a low rate of complications in our cohort, the large OR and effect size associated with the predictive abilities of the mFI-5 underscore its importance as a clinically relevant tool.”
Limitations of the study include the fact that the NSQIP database is designed to record surgical procedures in various specialties, but does not contain information on breast-related complications. In addition, the database is limited to a 30-day window, which may lead to a falsely lower complication rate because many complications (for example, rippling, capsular contracture, double capsules, and late seromas) occur later than 30 days after the procedure.
The researchers concluded: “Given the feasibility of the mFI-5, this tool offers surgeons a rapid and robust assessment of frailty and predictors of adverse outcomes during the preoperative assessment process.”
