THE ENHANCED MODIFIED FRAILTY INDEX SCORE IS A BETTER PREDICTOR FOR POSTOPERATIVE MORBIDITY AND MORTALITY AFTER WHIPPLE PROCEDURE COMPARED TO MODIFIED FRAILTY INDEX SCORE
Konstantinos A. Zorbas*1, Lois A. William1, Daniel T. Farkas1, Ajay Shah1, Vic Velanovich2, Andreas Karachristos2
1BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York, NY; 2University of South Florida, Morsani College of Medicine, Tampa, FL
Introduction
The Modified Frailty Index has been shown to predict mortality and morbidity after major operations like pancreatectomies. We sought to develop a more accurate and operation-specific predictor of postoperative morbidity and mortality in patients undergoing Whipple Procedure.
Methods
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2011, was queried for patients who underwent Whipple procedure. The Enhanced Modified Frailty Index was calculated by adding four variables in the known Modified Frailty Index (steroid use, bleeding disorder, preoperative albumin <3 and age>65). Thirty-day mortality and severe postoperative complications were evaluated.
Results
A total of 8546 patients were identified who met the inclusion criteria. Higher scores were associated with a step-wise greater risk of mortality and serious complications. A higher Enhanced Modified Frailty Index is associated with significantly higher rates of mortality (1% vs 10%, P<0.001), serious postoperative complications (27.4% vs 51.3%, P<0.001) and Clavien-Dindo IV complications (5.9% vs 28%, P<0.001), compared with the non-frail patients (Table). The Enhanced Modified Frailty Index demonstrated good discrimination and outperformed the previously proposed Modified Frailty Index when evaluated among patients included in the same cohort (Table).
Conclusion
The Enhanced Modified Frailty Index is a better predictor for postoperative serious complications and mortality after Whipple procedures, compared with the previously described Modified Frailty Index. Enhanced Modified Frailty Index can be easily calculated preoperatively, from a patient’s history and simple hematologic tests, and it can add valuable insight regarding the postoperative mortality and morbidity.
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