{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:01:16Z","timestamp":1790233276497,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Frailty may influence outcomes after pancreatoduodenectomy (PD). We compared the prognostic performance of the 11\u2010item modified Frailty Index (mFI\u201011) and the simplified 5\u2010item version (mFI\u20105) and explored their link with post\u2010pancreatectomy mortality (PPM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 1926 adults undergoing PD for periampullary lesions (2015\u20132023). Frailty was classified as non\u2010frail, mildly frail, or severely frail. Co\u2010primary outcomes were major complications, defined as Clavien\u2013Dindo grade\u00a0\u2265\u00a0III, and 90\u2010day mortality. Separate adjusted logistic models were fitted for each index; Firth regression was used for mortality sensitivity analyses. Discrimination was assessed by AUC and compared using DeLong tests. Deaths were independently adjudicated as PPM1, PPM2, or PPM3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Major complications occurred in 350 patients (18.2%), and 90\u2010day mortality was 52 (2.7%). Both indices showed a stepwise increase in event rates across frailty strata. In adjusted models, severe frailty was independently associated with mortality (mFI\u201011: OR 4.1, 95% CI 1.6\u201310.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001; mFI\u20105: OR 2.8, 95% CI 1.4\u20135.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.015 by Firth regression). Discrimination was modest and comparable between indices for major complications (AUC 0.629 vs. 0.630; DeLong\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.68) and good and comparable for mortality (AUC 0.761 vs. 0.757; DeLong\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.48). Severe frailty was independently associated with PPM2 deaths for both indices but not with PPM1 or PPM3, although the latter subgroups were underpowered.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The mFI\u20105 performs similarly to the mFI\u201011 after PD and is preferable for routine use due to its simplicity. Frailty is more strongly linked to mortality, especially pancreas\u2010specific failure\u2010to\u2010rescue trajectories, than to major morbidity alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70542","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:11:42Z","timestamp":1790230302000},"source":"Crossref","is-referenced-by-count":0,"title":["The Modified Frailty Index Predicts Failure\u2010to\u2010Rescue Mortality After Pancreatoduodenectomy: A Comparison of the 11\u2010Item and 5\u2010Item Versions"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5244-4357","authenticated-orcid":false,"given":"Matteo","family":"De Pastena","sequence":"first","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"},{"name":"University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6893-8618","authenticated-orcid":false,"given":"Salvatore","family":"Paiella","sequence":"additional","affiliation":[{"name":"University of Verona  Verona Italy"},{"name":"Pancreatic Surgery Unit Department of Surgery, Dentistry Paediatrics and Gynecology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Veneroni","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4635-3680","authenticated-orcid":false,"given":"Gabriella","family":"Lionetto","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Casule","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Derobertis","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Casciani","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pea","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2192-6365","authenticated-orcid":false,"given":"Nicola","family":"Gentilini","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7529-2603","authenticated-orcid":false,"given":"Elisa","family":"Venturini","sequence":"additional","affiliation":[{"name":"General and Pancreatic Surgery Department Pancreas Institute University and Hospital Trust of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3514-8473","authenticated-orcid":false,"given":"Roberto","family":"Salvia","sequence":"additional","affiliation":[{"name":"University of Verona  Verona Italy"},{"name":"Pancreatic Surgery Unit Department of Engineering for Innovation Medicine (DIMI) University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Malleo","sequence":"additional","affiliation":[{"name":"University of Verona  Verona Italy"},{"name":"Pancreatic Surgery Unit Department of Surgery, Dentistry Paediatrics and Gynecology University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004753"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2012.05.022"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010020\u201005462\u2010w"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000528561"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.1025"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.01.028"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2020.08.024"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010021\u201006436\u20102"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050051"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481708300837"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.12.168"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.20149"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006870"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2019.6035"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gassur.2006.02.003"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181e61e88"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2013.01.021"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000007019"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.11.014"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.05.005"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2007.02.001"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.06.058"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010016\u20105715\u20100"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957\u2010020\u201001969\u20107"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.07.010"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1159\/000522576"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2025.102197"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.27862"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000226"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010024\u201003483\u2010w"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i17.3077"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2021.101688"}],"container-title":["World 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