Efficacy of the Modified 5-Item Frailty Index in Predicting Surgical-Site Infections in Patients Undergoing Breast Implant Augmentation: A National Surgical Quality Improvement Project-Based 5-Year Study

Abstract

Abstract Background The ability to predict breast implant augmentation complications can significantly inform patient management. A frailty measure, such as the modified 5-item frailty index (mFI-5), is becoming an increasingly established risk factor for adverse postoperative outcomes. The authors hypothesized that the mFI-5 is predictive of 30-day postoperative complications in breast augmentation. Objectives To investigate if mFI-5 can predict the likelihood and magnitude of 30-day complications resulting from breast augmentations. Methods A retrospective review study of the National Surgical Quality Improvement Program database for patients who underwent breast implant augmentation without other concurrent procedures, from 2015 to 2019. Age, BMI, number of major comorbidities, American Society of Anesthesiologists (ASA) classifications, smoking status, mFI-5 score, and modified Charlson comorbidity index score were compared as predictors of all-cause 30-day complications and 30-day surgical-site complications using regression analyses. Results Overall, 2478 patients were analyzed, and among them, 53 patients developed complications (2.14%). mFI-5 score significantly predicted surgical-site infection (SSI) complications (odds ratio [OR] = 4.24, P = .026). Frail patients had a higher occurrence of SSIs than nonfrail patients (P = .049). Multivariable analyses showed ASA class predicted 30-day SSI complications (OR = 5.77, P = .027) and mFI-5 approached, but did not reach full significance in predicting overall 30-day complications (OR = 3.14, P = .085). Conclusions To date, the impact of frailty on breast implant procedure outcomes has not been studied. Our analysis demonstrates that the mFI-5 is a significant predictor for SSIs in breast implant augmentation surgery and is associated with overall complications. By preoperatively identifying frail patients, the surgical team can better account for postoperative support to minimize the risk of complications. Level of Evidence: 4