The Impact of Modified Frailty Index-5 on Postoperative Outcomes and Survival in Patients Undergoing Pneumonectomy

Background: Pneumonectomy is a major surgical procedure for central lung cancers but is associated with high morbidity and mortality. This study aimed to evaluate the association between the Modified Frailty Index-5 (mFI-5) score and major postoperative complications and overall survival in patients undergoing pneumonectomy.Methods: Seventy-four patients who underwent pneumonectomy for non–small cell lung cancer were retrospectivelyreviewed. Patients undergoing pneumonectomy for benign pathologies or non-NSCLC indications were excluded to maintain a homogeneous oncological cohort. The mFI-5 scores were calculated based on five parameters: diabetes, hypertension, heart failure, COPD, and functional dependence. Major complications were defined as Clavien–Dindo Grade ≥3. Independent prognostic factors were identified using multivariable logistic and Cox regression models.Results: The mean age was 59.1 ± 10.6 years, and 85.1% were male. Major postoperative complications occurred in 28.4% of patients. In multivariable analysis, mFI-5 was not independently associated with major postoperative complications. However, higher mFI-5 scores were independently associated with reduced overall survival (HR = 1.428, p = 0.048). The development of postoperative complications was the sole independent determinant of both intensive care unit and hospital length of stay.Conclusion: The mFI-5 score appears to be a practical and clinically accessible tool for preoperative risk stratification in pneumonectomy candidates. However, given the retrospective design and limited sample size, these findings should be interpreted with caution. mFI-5 may serve as a supportive parameter in identifying high-risk patients and guiding perioperative management strategies.