The Modified Fragility Index Predicts Major Complications in Oncoplastic Reduction Mammoplasty (OCR)

Background: An important component of preoperative counseling and patient selection involves surgical risk- stratification. There are many tools developed to predict surgical complications. The Modified Fragility Index (mFI) calculates risk based on the following five elements: hypertension, COPD, CHF, DM and functional status. Recent literature demonstrates the efficacy of the mFI across multiple surgical disciplines. We elected to investigate its utility in oncoplastic reductions (OCR). Methods: A retrospective review of all patients with breast cancer who underwent OCR from zto 2020 were queried from a prospectively maintained database. Patient demographics, comorbidities, and surgical details were reviewed. The mFI was computed for each patient. The primary clinical outcome was the development of complications. Results: 547 patients were included in the study cohort. The average age was 55 and the average BMI was 33.5. The overall complication rate was 19% (n=105) and the major complication rate was 9% (n=49). Higher fragility scores were significantly associated with the development of major complications (p=0.028). mFI scores of 0 had a major complication rate of 5.7%; scores of 1, 13%; and scores of 2, 15.1% (Table 1). The relative risk of a major complication in patients with elevated mFI (>0) was 2.2. Age, BMI and resection weights were not associated with complications (p=0.15, p=0.87 and p= 0.30 respectively). Conclusion: The mFI predicts surgical risk in patient who are undergoing oncoplastic reduction. Benefits of this risk assessment tool include its ease of calculation. Our study is the first to demonstrate its utility in OCR.