Do the Multidimensional Prognostic Index, Fried phenotype, and ASA physical status identify the same high-risk surgical patients? A prospective cohort study

This is the authors' abstract. We don't add key points for this paper.

Background The Multidimensional Prognostic Index (MPI), Fried phenotype, and American Society of Anesthesiologists Physical Status (ASA-PS) classification describe different aspects of perioperative vulnerability. We assessed whether they identify the same high-risk patients and contribute distinct information about in-hospital complications. Methods This analysis used a prospective two-centre cohort of adults undergoing elective abdominal surgery during 2023-2025. High risk was defined as MPI-2 or MPI-3, Fried frailty, and ASA III or IV. We quantified agreement with Cohen kappa and bootstrap 95% confidence intervals (CIs). Adjusted logistic models examined any Clavien-Dindo grade I-V complication; discrimination was evaluated with repeated 10-fold cross-validation. Results Among 223 patients, 217 had all three instruments. High-risk prevalence was 15.5% for MPI, 22.1% for Fried, and 45.2% for ASA-PS. Agreement was closest for Fried-MPI (κ=0.564, 95% CI 0.413-0.689) and lower for Fried-ASA (κ=0.306, 0.194-0.418) and MPI-ASA (κ=0.269, 0.166-0.375). Eighty-seven patients were high risk by only one or two instruments. In 214 complete cases with 77 complications, adjusted odds ratios per category were 2.64 (1.25-5.56) for MPI, 2.23 (1.33-3.74) for Fried, and 1.08 (0.66-1.77) for ASA-PS. Adding all three scores increased cross-validated AUC from 0.727 to 0.764 (difference 0.037, 95% CI -0.001 to 0.076). Additional adjustment for surgical approach and operative severity attenuated Fried’s association in the joint model. Conclusions The instruments did not define an interchangeable high-risk population. ASA III-IV identified a broader high-risk group, while the independent contributions of the instruments to postoperative morbidity remained uncertain after operative adjustment. The data do not support a new combined score.