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Frailty Predicts Morbidity, Complications, And Mortality In Patients Undergoing Complex Abdominal Wall Reconstruction.

Joseph WJ, Chow I, Beers EH
UPMC Department of Plastic Surgery
2017-01-29

Presenter: Walter J. Joseph, MD

Affidavit:
This submitted work is the original work of the resident.

Director Name: Vu T. Nguyen, MD

Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction

Frailty is becoming an increasingly established risk factor for adverse postoperative outcomes. Given the innate high morbidity involved in complex abdominal wall reconstruction (CAWR) and the propensity for comorbidities among this patient population, we sought out to determine the predictive utility of a frailty index in patients undergoing CAWR. A retrospective analysis was conducted using the National Surgical Quality Improvement Project (NSQIP) database. 70,339 patients undergoing CAWR were identified using CPT codes for ventral hernia repair +/- components separation technique, +/- placement of prosthetic or biologic mesh, and complexity of the defect. Pre-operative frailty index was calculating using the Modified Frailty Index (mFI). Outcomes included overall morbidity, Clavien-Dindo Grade IV complications, and mortality. 9,931 patients had a complication associated with their procedure and a calculated mFI 0.12 (±0.11) which was significantly greater than 0.077 (±0.85) for patients with no complications (p<0.001). When examining mFI correlation with Clavien-Dindo Grade IV complications (n=2,541), mFI once again was significantly greater (0.16±0.12) than those with no Grade IV complications (0.080±0.09; p<0.001). Multivariate analyses also showed that all individual factors of the mFI were predictive of any complications and Grade IV complications (p<0.001). Higher pre-operative mFI conferred a 7.77x likelihood of having any complication, 35.71x likelihood f having a Grade IV complication, 3.85x likelihood of having a surgical site complication, and a 62.05x likelihood of death (all p<0.001). We have shown that frailty as measured by mFI is an accurate predictor of morbidity, complications, and mortality in patients undergoing CAWR.

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