In Autologous Breast Reconstruction, Frailty Is a More Accurate Predictor of Postoperative Complications: A Retrospective Cohort Analysis

Abstract

Background: Autologous breast reconstruction has a higher postoperative complication rate in vulnerable patients. Given the high prevalence of obesity and aging, operative risk prediction is critical. Age, body mass index, and American Society of Anesthesiologists class are inaccurate predictive factors of postoperative complications. Frailty-a measure of vulnerability-was reported to be a reliable predictor of postoperative complications in multiple surgical fields. Here, we hypothesized that it would be an accurate predictor also in autologous breast reconstruction.

Methods: Patients undergoing autologous breast reconstruction (CPT code 19364) were identified using the American College of Surgeons National Surgical Quality Improvement Program database (January of 2010 to December of 2018). Frailty was calculated using the validated modified Frailty Index. Rates of wound complications, bleeding episodes, readmissions, returns to the operating room, and deep venous thromboses were compared across modified Frailty Index score, body mass index, age, and American Society of Anesthesiologists class.

Results: A modified Frailty Index score of 2 or greater was associated with a 22.22 percent ( p < 0.001) rate of wound complications; a 15.79 percent ( p < 0.001) rate of bleeding episodes; an 8.20 percent ( p < 0.001) rate of readmissions; a 17.19 percent ( p < 0.001) rate of return to the operating room; and a 1.81 percent ( p < 0.05) rate of deep venous thromboses. Higher body mass index, age, and American Society of Anesthesiologists class did not significantly correlate with increased rates in one or more postoperative complications. Only a high modified Frailty Index was consistently associated with significantly higher odds in all complication types.

Conclusion: As a reliable and accurate predictor of postoperative complications in autologous breast reconstruction, frailty could be used preoperatively to counsel patients and guide surgical care.

Clinical question/level of evidence: Risk, III.