Utilizing the Modified Frailty Index to Stratify Risk in Facial Fracture Management

Background: Facial fractures are common traumatic injuries with variable outcomes due to variations in etiologies, comorbidities, and anatomical complexity. Effective preoperative risk stratification is crucial for identifying patients at higher risk of complications. This study evaluates the utility of the Modified 5-Item Frailty Index (5-mFI) in predicting postoperative outcomes for patients undergoing surgical repair of facial fractures. Methods: A retrospective analysis was conducted using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data from 2011 to 2021. The 5-mFI score (0-5) was based on hypertension, diabetes, respiratory disease, heart failure, and functional dependence. Patients were stratified into low-risk (5-mFI < 2) and high-risk (5-mFI ≥ 2) groups. Statistical comparisons and multivariable logistic regression were used to evaluate outcomes. Results: Of 7549 patients, 6066 (80.4%) were included in the 5-mFI < 2 group and 1483 (19.6%) in the 5-mFI ≥ 2 group. The 5-mFI < 2 group was more functionally independent (99.36% vs 93.46%; P < .001). The 5-mFI ≥ 2 group had increased all-cause complications (28.46% vs 9.33%), wound complications (3.03% vs 1.07%), and readmissions (5.87% vs 2.26%; P < .001). This group encountered higher rates of bleeding (5.53% vs 0.91%) and wound dehiscence (2.09% vs 0.68%). Operative time (164.2 minutes vs 125.8 minutes) and hospital stay (2.49 days vs 1.31 days) were longer ( P < .001). Severe complications (1.89% vs 0.21%) and intubation (0.6% vs 0.1%) were higher in the 5-mFI ≥ 2 group. 5-mFI ≥ 2 was associated with hospital stays over 30 days ( P = .024). Conclusion: 5-mFI ≥ 2 patients experience more complications and delayed recovery. Integrating 5-mFI into preoperative assessments may improve patient communication and guide perioperative management.