Abstract
Background
Free flap reconstruction in the setting of lower extremity trauma continues to be
a challenging clinical problem fraught with a high risk of complications including
flap compromise. Although studies have described certain risk factors that predispose
these patients to poor outcomes, there remains a paucity of literature detailing frailty
as a risk factor. As such, the aim of our study was to examine the application of
the 5-item modified frailty index (mFI-5) in trauma patients undergoing lower extremity
free flap reconstruction.
Methods
The 2012 to 2020 American College of Surgeons-National Surgical Quality Improvement
Program database was queried for lower extremity free flap reconstructive procedures.
After excluding nontrauma etiologies, patients were stratified into three cohorts
by their respective mFI-5 score (0, 1, and ≥2). Univariate and multivariate logistic
regressions were performed to assess the effect of mFI-5 scores on postoperative complications.
Results
A total of 219 patients were included (64.8% male) with an average age of 47.6 ± 16
years. A total of 22.4% (n = 49) of patients had at least one complication. An increased mFI-5 score was associated
with an increase in any complication (p < 0.001), hematological complication (p = 0.023), and reoperation (p = 0.004) rates. A high mFI-5 score was found to be an isolated risk factor for having
at least one complication (mFI-5 ≥ 2: odds ratio [OR]: 3.829; p < 0.007; 95% confidence interval [CI]: 1.445–10.145) and reoperation (mFI-5 ≥ 2:
OR: 5.385; p < 0.002; 95% CI: 1.826–15.877).
Conclusion
Our results indicate that the mFI-5 can be a helpful assessment tool for lower extremity
trauma patients undergoing free flap reconstruction to predict the risk of surgical
complications and reoperation rates. Patients with an mFI-5 score > 2 should be counseled
preoperatively of their increased risk of complications.
Keywords
frailty - limb salvage - trauma - free flap - lower extremity - mFI-5
