D138. Does Frailty Predict Outcomes in Patients Undergoing Local, Regional or Free Flap Procedures At The Time Of Craniotomy? An Analysis of the ACS-NSQIP Database (2011-2021)

PURPOSE: Complications after craniotomy are costly and morbid. Patients at high-risk may undergo concurrent flap procedures. This study examines the impact of the modified frailty index (mFI-5) on postoperative outcomes in this high-risk neuroplastic cohort. METHODS: The ACS-NSQIP database (2011-2021) was queried by ICD-10 and CPT codes to identify craniotomy patients undergoing concurrent local, regional, or free flap closure. Clinical data were abstracted. The mFI-5 was calculated using functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure and hypertension. Patients were stratified by mFI-5: no frailty (0), low frailty (1), and high frailty (2+). Univariate and multivariate analysis were performed. RESULTS: Concurrent flap closure was performed in 515 craniotomy patients, with tumor being the most common indication. A majority of patients had no (n=247) or low frailty (n=185). Greater frailty was associated with increased age, BMI, ASA class, and smoking. Greater frailty was associated with greater length-of-stay and readmission rates. High frailty was associated with more all-cause, severe systemic complications, and death on univariate analysis and trended towards a higher odds of complications on adjusted analysis (OR 1.63, p=0.08). CONCLUSION: Among high-risk neuroplastic surgery patients, higher frailty is associated with increased risk of postoperative complications and resource utilization. This study highlights the importance of pre-habilitation and establishes mFI-5 as a validated predictor of outcomes for patients undergoing flap procedures with craniotomy.