{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:18:41Z","timestamp":1791566321165,"version":"4.3.4"},"reference-count":62,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T00:00:00Z","timestamp":1770508800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Advances in Wound Care"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Approach:<\/jats:title>\n                    <jats:p>A retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program database (2015\u20132021). Adults with type 2 diabetes and International Classification of Diseases, 10th Revision\u2013coded DFUs (E11.621) undergoing elective surgery were identified and stratified into frail (mFI-5 &gt;2) and prefrail (mFI-5 \u22642) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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\u20131.70,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.02) and medical complications (OR = 1.53, 95% CI: 1.12\u20132.07,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Innovation:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21621918261421637","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T03:36:41Z","timestamp":1770608201000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Frailty Predicts Postoperative Complications in Patients Undergoing Surgery for Diabetic Foot Ulcers"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1278-0505","authenticated-orcid":false,"given":"Felix J.","family":"Klimitz","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."},{"name":"Department of Hand, Replantation, and Microsurgery, Department of Burns and Plastic Surgery, BG Trauma Center Berlin, Chair of Hand, Replantation, and Microsurgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Berlin, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Knoedler","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."},{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Niederegger","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."},{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alzbeta","family":"Novotna","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stav","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dany Y.","family":"Matar","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliyar","family":"Zahedi Vafa","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."},{"name":"KU Leuven, Faculty of Medicine, Leuven, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Pomahac","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander S.","family":"Piribauer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, AUVA Trauma Center Meidling, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Knoedler","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennis P.","family":"Orgill","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Hundeshagen","sequence":"additional","affiliation":[{"name":"Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kauke-Navarro","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bohdan","family":"Pomahac","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana C.","family":"Panayi","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA."},{"name":"Department of Oral and Maxillofacial Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, 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