(A421) Modified 5-Item Frailty Index and Postoperative Outcomes Following Facial Reanimation Procedures

Introduction: Frailty has been associated with poor postoperative outcomes after facial plastic surgery procedures. This study evaluates the association between the modified 5-item frailty index (mFI-5) and postoperative outcomes following facial reanimation.

Methods: This study is a cross-sectional database study conducted in January 2025 utilizing the 2015-2017 National Surgical Quality Improvement Program (NSQIP) database. The NSQIP was retrospectively queried for patients undergoing facial reanimation procedures (nerve transfer, static procedures, regional muscle transfers, free tissue transfer). Cases were stratified by the mFI-5, a tool that evaluates the presence of hypertension requiring medication, congestive heart failure, lung pathology, functional health status, and diabetes mellitus. Univariate and multivariate analyses were performed to identify associations between mFI-5 and demographic, comorbid, and complication variables.

Results: A total of 1,766 patients undergoing facial reanimation procedures were stratified by the mFI-5. Univariate analysis demonstrated an increased incidence of medical complications, surgical complications, unplanned readmission, and reoperation with increasing mFI-5 score (p < 0.05). There was no significant correlation between mFI-5 score and mortality (p=0.100). Multivariate analysis displayed increased odds of any complication in patients with mFI-5 =1 (aOR 1.51; 95% CI: 1.16-1.95; p=0.002) and mFI-5 ≥2 (aOR 1.88; 95% CI: 1.32-2.67; p< 0.001) compared with mFI-5=0. There were also increased odds of unplanned readmission (aOR 2.18; 95% CI: 1.37-3.47; p=0.001) and reoperation (aOR 2.14; 95% CI: 1.53-3.00; p< 0.001) in patients with mFI-5 =1 compared with mFI-5=0.

Conclusions: The mFI-5 is associated with increased odds of medical and surgical complications, unplanned readmissions, and reoperations in patients undergoing facial reanimation procedures, independent of age, race, and all significant comorbidities. The mFI-5 can aid in the risk stratification of these patients and serve as a tool to inform clinical decision-making.