title: A modified frailty index to assess morbidity and mortality after lobectomy.
abstract: BACKGROUND
  Frailty has yet to be explored as a risk factor for thoracic surgery. We hypothesized that our modified frailty index (mFI) may be a predictor of morbidity and mortality following lobectomy.
  
  
  METHODS
  National Surgical Quality Improvement Program (NSQIP) participant use files were reviewed (2005-2010). Patients undergoing lobectomy were identified based on Current Procedural Terminology code 32480. We used an mFI with 11 variables, based on mapping the Canadian Study of Health and Aging Frailty Index to the NSQIP comorbidities. Data were analyzed using χ(2) test, independent sample t-test, Jonckheere-Terpstra test, and logistic regression.
  
  
  RESULTS
  Of 1940 open lobectomy patients identified, morbidity and mortality uniformly increased as the mFI increased; 14.9% of patients (75/504) with mFI of 0 had at least one complication, compared with 32% of patients (91/284) with mFI of 0.27 (P < 0.001). An mFI of 0 was associated with a mortality rate of 1% (5/504), compared with 5.6% (16/284) for mFI of 0.27 (P < 0001). Failure to wean from the ventilator, reintubation, surgical site infections, pneumonia, and Clavien 4 and above complications occurred in 1.8% (9/504), 2.6% (13/504), 2.2% (11/504), 5.4% (27/504), and 4.2% (21/504), respectively, in patients with an mFI of 0, compared with 7.4% (21/284), 7% (22/284), 3.2% (9/284), 10.9% (31/284), and 14.4% (41/284), respectively, in patients with mFI of 0.27.
  
  
  CONCLUSIONS
  This study demonstrates that the mFI may identify patients at higher risk for morbidity and mortality post-lobectomy. With the aging population, preoperative selection is important in minimizing morbidity and mortality and improving risk stratification for informed decision-making.
authors.affiliation: Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. athtsiouris@hotmail.com
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsiouris
authors.forename: Zane T
authors.initials: ZT
authors.lastname: Hammoud
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
authors.forename: Arielle
authors.initials: A
authors.lastname: Hodari
authors.forename: Jamil
authors.initials: J
authors.lastname: Borgi
authors.forename: Ilan
authors.initials: I
authors.lastname: Rubinfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008168:Lung / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures; D014481:United States / Q000453:epidemiology; D055815:Young Adult