Assessing the Impact of Frailty on Patient-Reported Outcomes and Clinical Complications in 2-Stage Implant-Based Breast Reconstruction.

Abstract

The 5-item modified frailty index (5-mFI) is used to predict clinical outcomes in breast reconstruction, but its relationship to patient-reported outcomes (PROs) after 2-stage implant-based reconstruction (IBR) is unclear. This study evaluates how frailty is associated with clinical outcomes and PROs using the BREAST-Q. The authors hypothesized that higher 5-mFI scores would correlate with poorer outcomes and PROs. Patients aged 18 years or older who underwent immediate 2-stage IBR from January of 2017 to April of 2023 were included. Complications (eg, reconstructive failure, salvage, cellulitis/infection, seroma, mastectomy skin flap necrosis) and BREAST-Q scores for sexual well-being, psychosocial well-being, satisfaction with breasts, and physical well-being of the chest (PWBC) were compared between low-frailty (5-mFI <2) and high-frailty (5-mFI ≥2) groups at baseline and at 6 months, 1 year, and 2 years after exchange. Of 2697 patients, 2569 (95%) were low frailty. Seroma rates differed significantly between frailty cohorts, but frailty status was not associated with complications on multivariable analysis. High-frailty patients reported significantly lower satisfaction with breasts preoperatively and 2 years after exchange. Low-frailty patients consistently had better PWBC scores than high-frailty patients. Physical well-being and sexual well-being scores were significantly higher in low-frailty patients preoperatively and at 6 months. Multivariable analysis confirmed that increased frailty was associated with lower PWBC scores. Although the 5-mFI has does not effectively predict outcomes for all aspects of the BREAST-Q, it may be useful for predicting PWBC for patients undergoing 2-stage IBR. Furthermore, it may not be an effective metric to predict IBR postoperative complications.