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. 2025 Sep 18:15589447251366678.
doi: 10.1177/15589447251366678. Online ahead of print.

The Modified 5-Item Frailty Index is a Predictor of Perioperative Complications in Digital Replantation

Thor S Stead  1 , Neel Vishwanath  2 , Nikhil Sobti  2 , Tareq Kheirbek  2 , Amy C Kite  2
Affiliations

The Modified 5-Item Frailty Index is a Predictor of Perioperative Complications in Digital Replantation

Thor S Stead et al. Hand (N Y). .

Abstract

Background: Digit replantation has a significant risk of postoperative complications including an estimated reoperation rate around 14%. This study evaluates the modified frailty index 5 (mFI-5) in predicting postoperative complications including reoperation for digit replantation.

Methods: The American College of Surgeons' National Surgical Quality Improvement Program database (2007-2019) was queried to identify patients who underwent upper extremity blood vessel repair distal to the wrist. Demographics, patient characteristics, mFI-5 scores, and all complications, including reoperation and readmission, were analyzed using univariate and multivariate analyses to identify associations between mFI-5 and complications.

Results: We identified 1336 patients who underwent digit replantation. Of those, 99 patients (7.4%) had mFI-5 ≥ 3. Frail patients were defined as having mFI-5 ≥ 3 based on prior literature. Higher mFI-5 scores correlated with increased rates of all-cause complications (mFI-5 ≥ 3: 51.5% vs mFI-5 = 0: 9.2%, P < .001), readmission (mFI-5 ≥ 3: 15.8% vs mFI-5 = 0: 2.2%, P < .001), and reoperation (mFI-5 ≥ 3: 8.8% vs mFI-5 = 0: 3.1%, P < .001). Multivariate analysis indicated that an mFI-5 score ≥ 3 significantly increased the rates of any complication (odds ratio [OR] = 9.1, 95% confidence interval [CI], 3.9-21.2, P < .001), mortality (OR = 5.4, 95% CI, 1.1-27.0, P = .04), surgical complications (OR = 7.5, 95% CI, 2.5-22.9, P < .001), and medical complications (OR = 13.4, 95% CI, 3.9-46.7, P < .001). These patients also had lower odds of home discharge (OR = 0.35, 95% CI, 0.22-0.56, P < .001) and higher odds of unplanned readmission (OR = 1.4, 95% CI, 1.3-1.5, P < .001) compared with those with mFI-5 = 0.

Conclusions: The mFI-5 is an effective tool for predicting adverse outcomes in digit replantation. It is simple to calculate preoperatively and aids in risk stratification, perioperative counseling, operative planning, and postoperative outcomes.

Keywords: anatomy; complications; diagnosis; digits; frailty; modified frailty index; mortality; nerve; nerve injury; perioperative; replant; trauma; vascular.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Patient selection, categorization, and CPT codes used for identification. Note. NSQIP = National Surgical Quality Improvement Program; CPT = current procedural terminology; mFI = modified frailty index.
Figure 1.
Patient selection, categorization, and CPT codes used for identification. Note. NSQIP = National Surgical Quality Improvement Program; CPT = Current Procedural Terminology; mFI = modified frailty index.
A line plot with four lines representing complication rates for different causes of death against modified frailty index scores.
Figure 2.
Graph depicting increasing rates of mortality, medical, surgical, and all-cause complications with increasing mFI-5 score. Note. mFI = modified frailty index.
See this image and copyright information in PMC

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