Predicting Postoperative Complications in Oncoplastic Surgery Using the Modified Frailty Index

Introduction: Preoperative evaluation is crucial in breast cancer patients undergoing oncoplastic surgery. The Modified 5-item Frailty Index (mFI) predicts postoperative complications. This study evaluates its effectiveness in oncoplastic surgery. Methods: Breast cancer patients from the National Surgical Quality Improvement Program database (2005-2020) undergoing oncoplastic surgery were included. Patients were stratified by the mFI, which includes hypertension, chronic obstructive pulmonary disease, chronic heart failure, diabetes, and functional status. Multivariate logistic regression assessed risk factors for complications. Results: Of 6086 breast cancer patients undergoing oncoplastic surgery, 3270 (53.7%) had mFI 0, 2089 (34.3%) had mFI 1, and 727 (12.0%) had mFI ≥2. Higher mFI was associated with older age, steroid use, higher American Society of Anesthesiologists classification, recent surgery, lower hematocrit, and hypoalbuminemia. Higher mFI correlated with more overall (7.7% versus 4.5% versus 4.3%), medical (1.7% versus 0.7% versus 0.1%), and wound complications (4.4% versus 2.1% versus 1.5%). Multivariate analysis showed mFI ≥2 as a risk factor for overall (odds ratio [OR] = 1.67), medical (OR = 5.24), and wound complications (OR = 1.73) but not operative complications. No differences were found between mFI 0 and 1. Conclusions: MFI ≥2 predicts higher overall complications, with five times the risk of medical issues and 70% more risk for wound complications. mFI 1 patients have similar outcomes to healthy ones. High mFI patients should receive preoperative counseling and tailored approach.