The Modified Frailty 5-Factor Index Predicts Adverse Outcomes After Ventral Hernia Repair in a National Database

Background: Ventral hernia repair (VHR) is a common procedure performed on a comorbid patient population at risk for complications, necessitating effective preoperative risk assessment. Previous research suggests that frailty better predicts adverse outcomes compared with historical risk proxies including age. We examined the association between frailty as measured by the 5-factor modified frailty index and postoperative complications following VHR as reported in the National Surgical Quality Improvement Program database.

Methods: A retrospective review of the National Surgical Quality Improvement Program database from 2015 to 2020 was performed for patients who underwent VHR with the component separation technique. Descriptive analyses were performed on demographics, comorbidities, American Society of Anesthesiologists class, and the modified frailty index score. Multivariable regression was conducted for frailty, age, other comorbidities, and hernia characteristics to determine the relationship to all-cause and surgical site complications, complication severity, complications with Clavien-Dindo score above 3, length of stay, readmission, and reoperation. All analyses were performed using R software. A P value less than 0.05 was considered statistically significant.

Results: A total of 14,575 patients were identified. Frailty was a significant predictor of all-cause complications, readmission, reoperation, and increasing length of stay. Increased age was a significant predictor for length of stay and severe systemic complications. Smoking status and American Society of Anesthesiologists class of 4 were associated with all outcomes. Body mass index predicted surgical site complications and reoperation.

Conclusions: Frailty can predict many postoperative complications of VHR with component separation technique and is an important element of risk prediction for potential surgical candidates.