Educational Objective: At the conclusion of this presentation, the participants should be able to understand the relationship between the modified frailty index and postoperative outcomes in facial trauma patients.
Objectives: The modified frailty index (mFi-5) is a 5 factor based index that has been shown to predict postoperative morbidity. We evaluate the relationship between the mFi-5 and postoperative complications in facial fracture patients.
Study Design: Retrospective database review.
Methods: The 2005-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of facial fractures. Each patient received a mFi-5 score from 0 to 5 depending on the number of the following comorbidities they possessed: hypertension requiring medication, diabetes mellitus, congestive heart failure, chronic obstructive pulmonary disease/pneumonia, and dependent functional status. Univariate and multivariate analyses were conducted.
Results: A total of 5,220 patients met inclusion criteria. The majority of patients were under the age of 40 (58.4%), male (75.9%), and White (51.6%). The most common mFi-5 score was 0 with 4,237 cases (81.2%) followed by 1 (719, 13.8%) and 2 (238, 4.6%). Compared to patients with mFi-5 of 0, those with a score of 3 had higher rates of life threatening medical complications (8.0% vs. 0.5%), surgical site infections (4.0% vs. 2.1%), and discharge destination other than home (36.0% vs. 4.8%). Multivariate regression analysis revealed significant associations between mFi-5 and septic shock (OR= 3.41 [1.24-9.34], p=0.017), myocardial infarction (OR=7.30 [1.08-49.51], p=0.042), and wound disruption (OR=1.96 [1.22-3.15], p=0.006). Increasing mFi-5 score was associated with a 0.41 day (95% CI=0.04-0.79, p=0.029) marginal increase in length of stay.
Conclusions: Increasing mFi-5 score is associated with longer length of stay, septic shock, myocardial infarction, and wound disruption. The mFi-5 can potentially help identify high risk facial fracture patients.