The 5-point Modified Frailty Index in Plastic and Reconstructive Surgery: Meta-analysis

Background: Frailty is regarded as a key predictor of adverse surgical outcomes. The 5-item modified frailty index (mFI-5) offers a simplified version of the validated 11-item risk stratification tool. Despite its use across surgical fields, its utility in plastic and reconstructive surgery remains underexplored. The purpose of this study was to evaluate and quantify the predictive value of frailty, as measured by the mFI-5 on postoperative outcomes in adult patients undergoing plastic and reconstructive surgery. Methods: PubMed, Embase, Web of Science, and Cochrane Library were systematically queried for studies comparing adverse events in frail (mFI-5 ≥ 2) versus nonfrail patients undergoing plastic and reconstructive surgery. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the risk of bias in non-randomized studies–of interventions tool, with evidence quality evaluated using the grading of recommendations, assessment, development and evaluation approach. Outcomes included surgical, medical, and any complications, readmission, reoperation, and mortality. Subgroup analyses were conducted by subject of study, database source, and study sample size. Results: Twenty-nine studies encompassing 302,641 patients were included. Frailty was significantly associated with increased odds of complications, readmission, reoperation, and mortality. Subgroup analyses by procedure type, database, and sample size consistently confirmed elevated risk across all outcomes, with varying degrees of statistical significance. Conclusions: Frailty, as measured by the mFI-5, is associated with an increased risk of postoperative complications, hospital readmission, reoperation, and mortality in plastic and reconstructive surgery patients. These findings support the integration of the index in clinical practice and preoperative patient evaluation and decision-making.