D56. The Modified 5-item Frailty Index Is a Predictor of Perioperative Complications in Upper Extremity Revascularization

PURPOSE: To evaluate the ability of the modified frailty index 5 (mFI-5), a validated comorbidity-based scale, to predict the risk of adverse postoperative complications in patients undergoing revascularization of the upper extremity. METHODS: 1359 patients who underwent upper extremity blood vessel repair by plastic surgeons were identified from the 2007-2019 American College of Surgeons National Surgical Quality Improvement Program. Univariate analysis of demographics, patient characteristics, and the mFI-5 vs. all complications identified significant associations. Following this, multivariate logistic regression was performed including all variables significant on univariate analysis and the mFI-5. RESULTS: Patients with a higher mFI-5 score displayed markedly higher rates of readmission (mFI=0: 2.2% vs. mFI≥3: 15.8%), reoperation (mFI=0: 3.1% vs. mFI≥3: 8.8%), mortality (mFI=0: 0.6% vs. mFI≥3: 17.8%), medical complications (mFI=0: 2.5% vs. mFI≥3: 28.7%), and surgical complications (mFI=0: 5.5% vs. mFI≥3: 24.8%). On multivariate analysis, an mFI-5 score of 3 or greater was significantly associated with increased rates of any complication (OR 7.62, 95% CI [3.36 - 17.27], p<0.0001), mortality (OR 5.61 [1.15 - 27.44], p=0.0334), surgical complications (OR 5.81 [2.05 - 16.45], p=0.0009), and medical complications (OR 8.76 [2.82 -27.17], p=0.0002). Stratification by age showed that the mFI-5 was a stronger risk predictor in older patients who are frail. CONCLUSION: Clinical implementation of the mFI-5 as a risk-stratifying tool can better inform preoperative counseling, operative planning, and postoperative surveillance.