• Thor S Stead, Tzong-Huei Herbert Chen, Andrew Maslow, and Shyamal Asher.
• Department of Anesthesiology, Warren Alpert Medical School of Brown University, Providence, RI.
• J. Cardiothorac. Vasc. Anesth. 2024 Oct 22.

ObjectivesTo investigate the utility of the five-item Modified Frailty Index (MFI-5) as a preoperative risk-stratification tool in video-assisted thoracoscopic surgery (VATS) for patients with the same American Society of Anesthesiologists (ASA) class.DesignThis was a retrospective cohort study utilizing data from The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database from 2008 to 2021.SettingThe NSQIP includes 685 participating hospitals in all 50 states, the majority being large, academic medical centers.ParticipantsAll patients undergoing VATS were identified via CPT codes in the deidentified NSQIP dataset. Patients with invalid values for any variables of interest or significant covariates were excluded.InterventionsNo interventions were applied to any patients in this retrospective cohort study.Measurements And Main Results69,145 patients undergoing VATS were included, with the largest number having single lobectomy (32%) or unilateral wedge resection (26%). A total of 1,277 (1.8%) had unplanned reintubation, and 1,155 (1.7%) had ventilator dependence (VentDep) >48 hours after surgery. Of these patients, 66% were ASA class 3. Overall, ASA classification had a stronger correlation with both VentDep rates (adjusted R2 difference: +6.1%) and reintubation rates (adjusted R2 difference: +1.5%) than the MFI-5 score. However, combining ASA class with MFI-5 score was a stronger predictor for both primary outcomes than the ASA class alone (adjusted R2 difference: +1.5%, p < 0.001). The MFI-5 had the strongest correlation with both outcomes among ASA class 3 patients, demonstrating exponentially increasing odds of VentDep and reintubation (MFI 3 v MFI 0: odds ratio = 5.1 [3.7, 7], p = 0.002). MFI-5 also helped classify risk within ASA class 2 patients but not as reliably as for ASA class 3 (ASA class 2 reintubation: increased probability from MFI 0-1 and 1-2; VentDep: increased probability from MFI 0-1 only, p = 0.005).ConclusionsThe MFI-5 is a comorbidity-based scale that can be calculated preoperatively and considers distinct, but complementary information to the ASA class. Among VATS patients with identical ASA classes 2 and 3, the MFI-5 further stratified risk for reintubation and ventilator dependence >48 hours postsurgery.Copyright © 2024 Elsevier Inc. All rights reserved.

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