SP03. The Modified Frailty Index (mFI-5) Predicts Adverse Outcomes Following Ventral Hernia Repair With Component Separation in a National Database

PURPOSE: Approximately 400,000 ventral hernia repairs (VHR) are performed annually in the United States, and complex abdominal wall reconstruction is often required for advanced repair. Experienced plastic surgeons may perform component separation technique, which is reserved for large and complex hernias. Associated costs of VHR present a substantial burden to the health care system, with repairs and other postoperative complications comprising a considerable proportion of costs. As hernia reoccurrence rate increases with subsequent reoperation and is associated with postoperative complications, it is crucial to perform effective preoperative risk assessment. Frailty measures have demonstrated increased predictive capability for various surgical complications as compared to historical surgical risk proxies including age, BMI, and other single comorbidities. The 5-factor modified Frailty Index (mFI-5) is a patient-specific measure based on existence of diabetes, congestive heart failure, chronic obstructive pulmonary disease, hypertension requiring medications, and functional health status. The purpose of this study was to examine the association between mFI-5 score and various postoperative complications following ventral hernia repair in patients who received component separation technique, as reported in the National Surgical Quality Improvement Program (NSQIP) database. METHODS: A retrospective review of the NSQIP database from 2015 to 2020 was performed for patients who underwent VHR with component separation technique. Descriptive analyses of demographics, comorbidities, ASA Class, mFI-5 score, complications, and incisional/ventral hernia repair were performed. Frailty scores were calculated for each patient, with a score of 1 considered mild frailty and ≥ 2 considered severe frailty. Multivariable regression was performed for frailty, age, BMI, smoking status, chronic steroid use, sex, ASA class, and hernia characteristics to determine relationship to all-cause 30-day complications, surgical site complications, length of stay, readmission and reoperation. All statistical analyses were performed using R software, and P < 0.05 was considered statistically significant. RESULTS: A total of 14,575 patients were identified. Mild frailty was a significant predictor of all-cause complications (OR 1.22, 95% CI 1.11-1.34), readmission (OR 1.20, 95% CI 1.06 - 1.37) and length of stay (OR 1.04, 95% CI 1.01-1.07) (p<0.05). Severe frailty was a significant predictor of all-cause complications (OR 1.50, 95% CI 1.34-1.68), readmission (OR 1.37, 95% CI 1.17-1.59) length of stay (OR 1.14, 95% CI 1.10-1.19) and reoperation (OR 1.24, 95% CI 1.01-1.52). Age was only a positive predictor for length of stay (OR 1.27, 95% CI 1.18 - 1.36) (P<0.05). Smoking status and ASA class of 4 were predictive of all outcomes. Elevated BMI was predictive of surgical site complications and reoperation. Chronic steroid use was predictive of length of stay CONCLUSION: Frailty, as measured by the mFI-5 index, has predictive capacity for many postoperative complications for VHR with component separation technique. Given the high comorbidity prevalence and complication rate in patients receiving component separation for ventral hernia repair, there is a role for preoperative frailty assessment in risk stratification and optimizing safe patient outcomes