What question did this study set out to answer?

The study aims to evaluate whether frailty, quantified by the mFI-5, predicts postoperative complications in diabetic foot ulcer surgeries.

February 11, 2026

Frailty Predicts Postoperative Complications in Patients Undergoing Surgery for Diabetic Foot Ulcers

Key Points

The study aims to evaluate whether frailty, quantified by the mFI-5, predicts postoperative complications in diabetic foot ulcer surgeries.
Conducted a retrospective cohort analysis using the ACS National Surgical Quality Improvement Program database.
Identified patients with type 2 diabetes undergoing elective surgery for diabetic foot ulcers.
Stratified patients into frail and prefrail groups based on the mFI-5 score.
Compared preoperative variables and postoperative outcomes using statistical tests and logistic regression.
25.3% of patients were classified as frail.
Frail patients experienced significantly higher overall complication rates (50.6% vs. 32.9%) and higher mortality (4.1% vs. 1.6%).
Frailty was an independent predictor of any postoperative complication (odds ratio 1.34) and medical complications (odds ratio 1.53).

Abstract

Objective: To determine whether frailty, as quantified using the Five-Item Modified Frailty Index (mFI-5), independently predicts postoperative complications in patients undergoing surgery for diabetic foot ulcers (DFUs), and to assess its utility as a clinical risk stratification tool. Approach: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2015–2021). Adults with type 2 diabetes and International Classification of Diseases, 10th Revision–coded DFUs (E11.621) undergoing elective surgery were identified and stratified into frail (mFI-5 >2) and prefrail (mFI-5 ≤2) groups. Preoperative variables, perioperative characteristics, and 30-day postoperative outcomes were compared using univariate tests, followed by multivariable logistic regression adjusting for clinically relevant confounders. The study design, reporting, and analysis followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for observational cohort studies. Results: Among 2,819 patients, 714 (25.3%) were classified as frail. Frail patients had significantly higher rates of overall complications (50.6% vs. 32.9%), mortality (4.1% vs. 1.6%), and medical complications, including reintubation and urinary tract infection. In adjusted models, frailty independently predicted any postoperative complication (odds ratio OR = 1.34, 95% confidence interval CI 1.05–1.70, p = 0.02) and medical complications (OR = 1.53, 95% CI: 1.12–2.07, p = 0.007). Innovation: This is the first large-scale study applying the mFI-5 to DFU surgery, demonstrating that frailty provides prognostic information beyond traditional comorbidity-based assessments and offers a rapid, objective tool for perioperative risk evaluation. Conclusion: Frailty, as measured by the mFI-5, independently predicts postoperative morbidity and mortality after DFU surgery. Incorporating preoperative frailty screening may improve surgical decision making, resource allocation, and enhance outcomes in this high-risk population.

اسأل الذكاء الاصطناعي

Bookmark