Frailty Predicts Postoperative Complications in Patients Undergoing Surgery for Diabetic Foot Ulcers.

IF 5.7 3区医学 Q1 DERMATOLOGY

Advances in wound care Pub Date : 2026-02-08 DOI:10.1177/21621918261421637

Felix J Klimitz, Samuel Knoedler, Tobias Niederegger, Alzbeta Novotna, Stav Brown, Dany Y Matar, Aliyar Zahedi Vafa, Anna Pomahac, Alexander S Piribauer, Leonard Knoedler, Dennis P Orgill, Gabriel Hundeshagen, Martin Kauke-Navarro, Bohdan Pomahac, Adriana C Panayi

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Abstract

Objective: To determine whether frailty, as quantified using the Five-Item Modified Frailty Index (mFI-5), independently predicts postoperative complications in patients undergoing surgery for diabetic foot ulcers (DFUs), and to assess its utility as a clinical risk stratification tool.

Approach: A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2015-2021). Adults with type 2 diabetes and International Classification of Diseases, 10th Revision-coded DFUs (E11.621) undergoing elective surgery were identified and stratified into frail (mFI-5 >2) and prefrail (mFI-5 ≤2) groups. Preoperative variables, perioperative characteristics, and 30-day postoperative outcomes were compared using univariate tests, followed by multivariable logistic regression adjusting for clinically relevant confounders. The study design, reporting, and analysis followed the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for observational cohort studies.

Results: Among 2,819 patients, 714 (25.3%) were classified as frail. Frail patients had significantly higher rates of overall complications (50.6% vs. 32.9%), mortality (4.1% vs. 1.6%), and medical complications, including reintubation and urinary tract infection. In adjusted models, frailty independently predicted any postoperative complication (odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.05-1.70, p = 0.02) and medical complications (OR = 1.53, 95% CI: 1.12-2.07, p = 0.007).

Innovation: This is the first large-scale study applying the mFI-5 to DFU surgery, demonstrating that frailty provides prognostic information beyond traditional comorbidity-based assessments and offers a rapid, objective tool for perioperative risk evaluation.

Conclusion: Frailty, as measured by the mFI-5, independently predicts postoperative morbidity and mortality after DFU surgery. Incorporating preoperative frailty screening may improve surgical decision making, resource allocation, and enhance outcomes in this high-risk population.

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虚弱可以预测糖尿病足溃疡手术患者的术后并发症。

目的：确定用五项修正虚弱指数（mFI-5）量化的虚弱是否能独立预测糖尿病足溃疡（DFUs）手术患者的术后并发症，并评估其作为临床风险分层工具的实用性。方法：采用美国外科医师学会国家手术质量改进计划数据库（2015-2021）进行回顾性队列分析。接受择期手术的成人2型糖尿病和国际疾病分类第10版编码DFUs （E11.621）患者被确定并分层为虚弱组（mFI-5≤2）和虚弱前组（mFI-5≤2）。采用单变量检验比较术前变量、围手术期特征和术后30天的结果，然后对临床相关混杂因素进行多变量logistic回归调整。本研究的设计、报告和分析遵循《加强观察性队列研究的流行病学观察性研究报告指南》。结果：2819例患者中，虚弱714例（25.3%）。体弱患者的总并发症（50.6%对32.9%）、死亡率（4.1%对1.6%）和医疗并发症（包括再插管和尿路感染）的发生率均显著高于对照组。在调整后的模型中，虚弱独立预测任何术后并发症（优势比[OR] = 1.34, 95%可信区间[CI] 1.05-1.70, p = 0.02）和医学并发症（OR = 1.53, 95% CI: 1.12-2.07, p = 0.007）。创新：这是首次将mFI-5应用于DFU手术的大规模研究，表明虚弱提供了传统的基于合并症的评估之外的预后信息，并为围手术期风险评估提供了快速、客观的工具。结论：由mFI-5测量的虚弱可以独立预测DFU术后的发病率和死亡率。结合术前虚弱筛查可以改善手术决策，资源分配，并提高这一高危人群的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in wound care Medicine-Emergency Medicine

CiteScore

12.10

自引率

4.10%

发文量

期刊介绍： Advances in Wound Care rapidly shares research from bench to bedside, with wound care applications for burns, major trauma, blast injuries, surgery, and diabetic ulcers. The Journal provides a critical, peer-reviewed forum for the field of tissue injury and repair, with an emphasis on acute and chronic wounds. Advances in Wound Care explores novel research approaches and practices to deliver the latest scientific discoveries and developments. Advances in Wound Care coverage includes: Skin bioengineering, Skin and tissue regeneration, Acute, chronic, and complex wounds, Dressings, Anti-scar strategies, Inflammation, Burns and healing, Biofilm, Oxygen and angiogenesis, Critical limb ischemia, Military wound care, New devices and technologies.