“Frailty Indices Outperform Historic Risk Proxies as Predictors of Post-Abdominoplasty Complications: An Analysis of a National Database”

Background: While age, BMI, and major comorbidities were historically used as predictors of surgical risk, recent literature supports patient frailty as a more accurate predictor. Database studies and chart reviews support the modified Charlson Comorbidity Index (mCCI) and the Modified 5-Item Frailty Index (mFI-5) as predictors of postsurgical complications in plastic surgery. The authors hypothesized that the mFI-5 and mCCI are more predictive of abdominoplasty complications than historic risk proxies. Methods: A retrospective review of the NSQIP database was performed, for abdominoplasty patients from 2013 to 2019. Demographics, comorbidities, and complications were gathered. The mFI-5 and mCCI scores were calculated per patient. Age, BMI, major comorbidities, ASA class, mFI-5 score, and mCCI score were compared as predictors of all-cause 30-day complications, 30-day surgical site complications, length of stay, and aggregate Clavien-Dindo complication severity score. Results: Of 421 patients, the strongest predictors for all-cause complications and complication severity were mCCI score ≥ 3 and mFI-5 score ≥2. mFI-5 score was the strongest predictor of unplanned reoperation. Length of stay was best predicted by age ≥ 65. The only predictor of surgical site complications was BMI ≥ 30.0. Smoking was predictive of complication severity, but not any other outcome. Conclusions: The mFI-5 and mCCI are stronger outcome predictors than historically-used factors, which showed little predictive value in this cohort. While the mCCI is a stronger predictor than the mFI-5, the mFI-5 is easily calculated during an initial consultation. Surgeons can apply these tools to aid in risk stratification for abdominoplasty.