{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T01:58:35Z","timestamp":1770775115715,"version":"3.50.0"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Risk stratification for complex procedures such as microsurgical reconstruction of the lower extremities is an important part of preoperative planning and counseling. The aim of this study was to determine the effectiveness of the modified five\u2010item frailty index (5\u2010mFI) score, a validated tool for assessing risk in surgical patients, in predicting postoperative complications after lower extremity (LE) free flap reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS\u2010NSQIP) database was conducted from 2010 to 2020 on patients who underwent LE free\u2010flap reconstruction. 5\u2010mFI scores were calculated and patients were categorized as 5\u2010mFI\u2009\u22652 or &lt;2.<\/jats:p><jats:p>The primary endpoint was the presence of 30\u2010day overall complications. The secondary endpoints included 30\u2010day readmission, need for reoperation, and need to discharge to a care facility. Comparisons were made using one\u2010way analysis of variances, Pearson's chi\u2010squared test, or Fisher's extract test. Multivariable logistic regression models were performed for sex, age, BMI, smoker status, operative time, and ASA classification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total of 294 (61.6% males) patients were identified. Univariate analysis showed 5\u2010mFI\u2009\u22652 had higher rates of overall complications (<jats:italic>p<\/jats:italic>\u2009=\u2009.043) and hematologic complications (<jats:italic>p<\/jats:italic>\u2009=\u2009.033). In this population, there were also higher rates of reoperation (<jats:italic>p<\/jats:italic>\u2009=\u2009.003) and discharge to care facility (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Multivariable regression models further substantiated that 5\u2010mFI\u2009\u22652 was independently associated with increased overall complications [2.46, CI: 1.10\u20135.59, <jats:italic>p<\/jats:italic>\u2009=\u2009.031], hematologic complications [2.55, 1.02\u20136.35, <jats:italic>p<\/jats:italic>\u2009=\u2009.046], reoperation [4.55, 1.54\u201313.3, <jats:italic>p<\/jats:italic>\u2009=\u2009.006], and discharge to facility [2.86, 1.27\u20136.45, <jats:italic>p<\/jats:italic>\u2009=\u2009.011].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is a strong association of 5\u2010mFI\u2009\u22652 with adverse post\u2010operative outcomes in male patients undergoing LE free\u2010flap reconstruction. This can be a valuable adjunct in the counsel of patients for whom lower extremity salvage is feasible.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31092","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T04:14:41Z","timestamp":1689740081000},"page":"657-664","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Evaluation of modified frailty index for predicting post\u2010operative outcomes after lower\u2010extremity free\u2010flap reconstruction"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5430-7572","authenticated-orcid":false,"given":"Mustafa T. 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Surgery University of Texas Health San Antonio  San Antonio Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard T.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery University of Texas Health San Antonio  San Antonio Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rayaad C.","family":"Hosein","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery University of Texas Health San Antonio  San Antonio Texas 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