Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

Objective: To assess the ability of a modified frailty index (mFI-5) score, which includes the presence of congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status, and to identify patients at increased risk of complications after surgical treatment of long-bone nonunions/malunions. Design: Retrospective. Setting: Hospitals participating in the 2005–2018 American College of Surgeons National Surgical Quality Improvement Program. Patients/Participants: Patients in the American College of Surgeons National Surgical Quality Improvement Program database with upper extremity and lower extremity fractures were enrolled. Intervention: Surgical repair of nonunions/malunions of upper and lower extremity long bones. Main Outcome Measure: Postoperative complications after long-bone nonunion/malunion surgery. Results: Respective univariate analysis of the 2964 UE [1786 (60.3%) with mFI-5 of 0 and 386 (13.0%) with mFI-5 ≥2] and 3305 LE [1837 (55.6%) with mFI-5 of 0 and 498 (15.1%) with mFI-5 ≥2] showed that increasing mFI-5 score was associated with medical complications, extended longer length of stay, adverse discharge, and readmission. Binomial logistic regression showed that UE patients with mFI-5 ≥2 had increased risk of wound complications [odds ratio (OR) 2.512, 95% (confidence interval) CI: 1.037–6.086, P = 0.041), adverse discharge (OR 1.735, 95% CI: 1.204–2.499, P = 0.003), and unplanned readmission (OR 2.102, 95% CI: 1.038–4.255, P = 0.039), while LE patients with mFI-5 ≥2 had an increased risk of medical complications (OR 1.847, 95% CI: 1.307–2.610, P = 0.001), cumulative morbidity (OR 1.835, 95% CI: 1.342–2.510, P < 0.001), extended longer length of stay (OR 1.809, 95% CI: 1.233–2.654, P = 0.002), and adverse discharge (OR 1.841, 95% CI: 1.394–2.432, P < 0.001). Conclusions: mFI-5 score ≥2 is associated with significant increase in postoperative complications after surgical repair of long-bone nonunions/malunions. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.