Applying the modified five-item frailty index to predict complications following lower-extremity free-flap reconstruction in trauma patients

Authors: Gonzalez M, Zietowski M, Patel R, Chattha A, Cripps CN, Beederman M 

Affiliation: Section of Plastic & Reconstructive Surgery, University of Chicago Medicine 

Journal: Journal of Reconstructive Microsurgery, Jan 2025  

PMID: 39875120 

Key takeaways 

• The five-factor modified frailty index (mFI-5) provides a model to determine surgical risk and guide clinical decision making across specialties  

• The five variables include functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure and hypertension. 

• In 219 trauma patients, mFI-5 ≥2 was a statistically significant indicator predictive of: any complication (OR 3.83), reoperation (OR 5.39), and hematologic complications (OR 3.67). 

• mFI-5 = 1 was not predictive; BMI independently predicted wound infection (OR 1.09 per BMI unit). 

Background 

Lower-extremity trauma reconstructions have high complication rates; the role of frailty (mFI-5) as a risk stratifier in this cohort has been unclear. 

Objective 

Assess whether mFI-5 predicts postoperative complications after lower-extremity free-flap reconstruction for trauma. 

Methods 

• Design: Retrospective NSQIP analysis (2012–2020). 

• Cohort: n=219 trauma patients undergoing lower-extremity free flaps; grouped by mFI-5 = 0, 1, ≥2. 

• Outcomes (30 days): any complication, wound infection, hematologic complication (transfusion/DVT), readmission, reoperation, discharge destination, prolonged LOS. 

• Stats: Univariate tests + multivariable logistic regression; p<0.05. 

Results 

• Patient profile: Mean age 47.6 ±16.2; 64.8% male. Distribution: mFI-5 0 (65.3%), 1 (25.6%), ≥2 (9.1%). Higher mFI-5 associated with older age, higher BMI, and dyspnea. 

• Event rates: Any complication 22.4% (49/219); readmission 6.8%; reoperation 12.3%. 

• mFI-5 ≥2 (vs 0): 

• Any complication: OR 3.829, 95% CI 1.45–10.15, p=0.007. 

• Reoperation: OR 5.385, 1.83–15.88, p=0.002. 

• Hematologic: OR 3.669, 1.27–10.64, p=0.017. 

• mFI-5 = 1: Not significant for any complication, wound infection, readmission, or reoperation. 

• Other predictors: BMI predicted wound infection (OR 1.092, p=0.014); age predicted discharge to facility (OR 1.03 per year, p=0.009). 

Conclusion 

In trauma patients undergoing lower-extremity free-flap reconstruction, mFI-5 ≥2 robustly identifies those at higher risk of complications, reoperation, and hematologic events. Incorporating mFI-5 into preoperative assessment can sharpen counseling and postoperative planning. 

Strengths & limitations 

• Strengths: National dataset; focused trauma cohort; adjusted analyses demonstrating independent predictive value of mFI-5 ≥2. 

• Limitations: 30-day outcomes only; database constraints (e.g., flap-specific details, socioeconomic factors); modest mFI-5 ≥2 sample (n=20). 

Clinical relevance 

• Consider frailty when completing presurgical screening for LE trauma patients: Calculate mFI-5; flag ≥2 as high risk—plan tighter hemostasis, early DVT prophylaxis, and closer monitoring. 

• Target modifiable risks: Address BMI-related wound risks (glucose control, nutrition, offloading) and plan resources for higher discharge support with increasing age.