2032 The Modified 5 Item Frailty Index as a Predictor of Length of Stay and Complications After Nerve Transfer Surgery: A Nationwide Study

INTRODUCTION: The modified 5-item frailty index (mFI-5) is a comorbidity-based, risk stratification tool that has been well established to be able to predict adverse events following many surgeries. METHODS: We utilized the ACS-NSQIP dataset was used to identify all patients undergoing nerve transfers as a primary procedure between 2007 and 2021. The mFI-5 score was calculated based on the standard 5 comorbidities: congestive heart failure within 30 days of surgery, diabetes mellitus, chronic obstructive pulmonary disease, functional health status, and hypertension requiring medication. T-test was used for continuous variables and Chi Squared for categorical ones. Univariate analysis was used to identify the association between mFI-5 and post-operative complications. RESULTS: A total of 3209 patients with 1383 female (43%) and 1826 males (57%). The mFI-5 calculation was split into 3 categories: 0, 1, and 2 or more. Out of the 3209 patients, 2248 patients had a score of 0 (70%), 718 with a score of 1 (22%), and 243 with a score of 2+ (8%). We found statistical significance with the following complications: occurrences of myocardial infarction (p<0.001), bleeding (p<0.001), deep incisional surgical site infection (p<0.001), pneumonia (p<0.001), unplanned intubation (p<0.001), remaining on a ventilator for greater than 48 hours (p<0.001), cardiac arrest (p=0.033), post-operative dialysis (p<0.001), blood transfusions (p<0.001), CVA or stroke with neurological deficit (p=0.003), return to the operating room (p<0.001), and overall complications (p<0.001). In univariate analysis, mFI-5=1 (OR1.5, CI1.3-1.8, p<0.001) and mFI-5>=2 (OR1.7, CI1.3-2.2,p<0.001) were associated with higher risk of overall complications. CONCLUSIONS: We find that the mFI-5 is a strong correlative factor with post-operative complications in nerve transfer. Integrating mFI-5 into pre-operative assessments may enhance patient risk management and surgical planning.