The Modified 5-Item Frailty Index is a Predictor of Perioperative Complications in Digital Replantation

Background: Digit replantation has a significant risk of postoperative complications including an estimated reoperation rate around 14%. This study evaluates the modified frailty index 5 (mFI-5) in predicting postoperative complications including reoperation for digit replantation. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program database (2007-2019) was queried to identify patients who underwent upper extremity blood vessel repair distal to the wrist. Demographics, patient characteristics, mFI-5 scores, and all complications, including reoperation and readmission, were analyzed using univariate and multivariate analyses to identify associations between mFI-5 and complications. Results: We identified 1336 patients who underwent digit replantation. Of those, 99 patients (7.4%) had mFI-5 ≥ 3. Frail patients were defined as having mFI-5 ≥ 3 based on prior literature. Higher mFI-5 scores correlated with increased rates of all-cause complications (mFI-5 ≥ 3: 51.5% vs mFI-5 = 0: 9.2%, P < .001), readmission (mFI-5 ≥ 3: 15.8% vs mFI-5 = 0: 2.2%, P < .001), and reoperation (mFI-5 ≥ 3: 8.8% vs mFI-5 = 0: 3.1%, P < .001). Multivariate analysis indicated that an mFI-5 score ≥ 3 significantly increased the rates of any complication (odds ratio [OR] = 9.1, 95% confidence interval [CI], 3.9-21.2, P < .001), mortality (OR = 5.4, 95% CI, 1.1-27.0, P = .04), surgical complications (OR = 7.5, 95% CI, 2.5-22.9, P < .001), and medical complications (OR = 13.4, 95% CI, 3.9-46.7, P < .001). These patients also had lower odds of home discharge (OR = 0.35, 95% CI, 0.22-0.56, P < .001) and higher odds of unplanned readmission (OR = 1.4, 95% CI, 1.3-1.5, P < .001) compared with those with mFI-5 = 0. Conclusions: The mFI-5 is an effective tool for predicting adverse outcomes in digit replantation. It is simple to calculate preoperatively and aids in risk stratification, perioperative counseling, operative planning, and postoperative outcomes.