, Volume 23, Issue 5, pp 891–898 | Cite as

Ventral hernia repair outcomes predicted by a 5-item modified frailty index using NSQIP variables

  • F. M. BallaEmail author
  • C. G. Yheulon
  • J. L. Stetler
  • A. D. Patel
  • E. Lin
  • S. S. Davis
Original Article



Frailty is a decrease in physiologic reserve that is separate from the normal aging process. Previously, an 11-item modified frailty index (mFI) using NSQIP variables predicted outcomes for surgical patients. We aim to validate a condensed 5-item mFI in ventral hernia patients and determine outcomes and the relative impact of each frailty variable.


The NSQIP database was queried from 2011 to 2016 for patients undergoing VHR. Spearman’s rho correlation was used to determine the degree of correlation between 11-item and 5-item mFI raw frailty scores. Chi squared testing was used to determine odds ratios (95% CI) for accumulating frailty variables in both indices with regard to complications vs a baseline of zero variables present on the 11-item scale. Complications were defined by the Clavien–Dindo (CD) classification. Univariate and multivariate analyses were performed on each frailty variable to determine their relative weighted impacts on outcomes.


97,905 patients (99.45%) had all five frailty variables recorded. Only 11,549 patients (11.73%) had all variables from the 11-item mFI. No difference existed between groups for the five mutually shared frailty variables, BMI, emergent vs non-emergent procedures, operative time, or operative approach. For accumulating variables in both indices, the 5-item mFI predicts incidence of any complications, major complications, and discharge not to home similarly to the 11-item mFI. The most significantly weighted variable for complications and discharge not to home is functional status.


A 5-item mFI accurately predicts outcomes similar to the validated 11-item mFI and captures more patients for analysis.


Frailty Ventral hernia NSQIP Modified frailty index Outcomes 


Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interests or other disclosures.

Ethical approval

Approval from the institutional review board was not required for this study.

Human and animal rights

This article does not contain studies with human participants or animals performed by any of the authors given its retrospective nature.

Informed consent

Given the retrospective nature of this review, formal consent is not required.


  1. 1.
    Chimukangara M, Frelich MJ, Bosler ME et al (2016) The impact of frailty on outcomes of paraesophageal hernia repair. J Surg Res 202(2):259–266CrossRefGoogle Scholar
  2. 2.
    Mitnitski AB, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. Sci World J 1:323–336CrossRefGoogle Scholar
  3. 3.
    NSQIP (2018) NSQIP query for ventral hernia repair in the United States 2011–2016. Query published 2018Google Scholar
  4. 4.
    Pilotto A, Rengo F, Marchionni N et al (2012) Comparing the prognostic accuracy for all-cause mortality of frailty instruments: a multicentre 1-year follow-up in hospitalized older patients. PLoS One 7(1):e29090CrossRefGoogle Scholar
  5. 5.
    Velanovich V, Antoine H, Swartz A et al (2013) Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res 183(1):104–110CrossRefGoogle Scholar
  6. 6.
    Li JL, Henderson MA, Revenig LM et al (2016) Frailty and one-year mortality in major intra-abdominal operations. J Surg Res 203(2):507–512 (e501) CrossRefGoogle Scholar
  7. 7.
    Flexman AM, Charest-Morin R, Stobart L et al (2016) Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease. Spine J 16(11):1315–1323CrossRefGoogle Scholar
  8. 8.
    McIsaac DI, Bryson GL, van Walraven C (2016) Association of frailty and 1-year postoperative mortality following major elective noncardiac surgery: a population-based cohort study. JAMA Surg 151(6):538–545CrossRefGoogle Scholar
  9. 9.
    Chimukangara M, Helm MC, Frelich MJ et al (2017) A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surg Endosc 31(6):2509–2519CrossRefGoogle Scholar
  10. 10.
    Subramaniam S, Aalberg JJ, Soriano RP, Divino CM (2018) New 5-factor Modified Frailty Index using American College of Surgeons NSQIP data. J Am Coll Surg 226(2):173–181 (e178) CrossRefGoogle Scholar
  11. 11.
    Augenstein AV, Colavita DP, Wormer B et al (2015) CeDAR: carolinas equation for determining associated risks. J Am Coll Surg 221:S65–S66CrossRefGoogle Scholar
  12. 12.
    Fligor JE, Lanier ST, Dumanian GA. Current risk stratification systems are not generalizable across surgical technique in midline ventral hernia repair. Plast Reconstr Surg Glob Open 2017;5(3):1–6 (e1206) CrossRefGoogle Scholar
  13. 13.
    Yahchouchy-Chouillard E, Aura T, Picone O et al (2003) Incisional hernias. I. Related risk factors. Dig Surg 20(1):3–9CrossRefGoogle Scholar
  14. 14.
    Rogmark P, Petersson U, Bringman S et al (2013) Short-term outcomes for open and laparoscopic midline incisional hernia repair: a randomized multicenter controlled trial: the ProLOVE (prospective randomized trial on open versus laparoscopic operation of ventral eventrations) trial. Ann Surg 258(1):37–45CrossRefGoogle Scholar
  15. 15.
    Bittner R, Bingener-Casey J, Dietz U et al (2014) Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society [IEHS])-Part 2. Surg Endosc 28(2):353–379CrossRefGoogle Scholar
  16. 16.
    Albright EL, Davenport DL, Roth JS (2012) Preoperative functional health status impacts outcomes after ventral hernia repair. Am Surg 78(2):230–234PubMedGoogle Scholar
  17. 17.
    Lindmark M, Strigard K, Lowenmark T et al (2018) Risk factors for surgical complications in ventral hernia repair. World J Surg 42:3528–3536CrossRefGoogle Scholar
  18. 18.
    Bieniek J, Wilczyński K, Szewieczek J (2016) Fried frailty phenotype assessment components as applied to geriatric inpatients. Clin Intervent Aging 11:453–459Google Scholar
  19. 19.
    Khan MA, Grinberg R, Johnson S et al (2013) Perioperative risk factors for 30-day mortality after bariatric surgery: is functional status important? Surg Endosc 27(5):1772–1777CrossRefGoogle Scholar
  20. 20.
    Crawford RS, Cambria RP, Abularrage CJ et al (2010) Preoperative functional status predicts perioperative outcomes after infrainguinal bypass surgery. J Vasc Surg 51(2):351–358 (discussion 358–359) CrossRefGoogle Scholar
  21. 21.
    Saraiva MD, Karnakis T, Gil-Junior LA et al Jacob-Filho W (2017) Functional status is a predictor of postoperative complications after cancer surgery in the very old. Ann Surg Oncol 24(5):1159–1164CrossRefGoogle Scholar
  22. 22.
    Rosen MJ, Bauer JJ, Harmaty M et al (2017) Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg 265(1):205–211CrossRefGoogle Scholar
  23. 23.
    Balentine CJ, Naik AD, Berger DH et al (2016) Postacute care after major abdominal surgery in elderly patients: Intersection of age, functional status, and postoperative complications. JAMA Surg 151(8):759–766CrossRefGoogle Scholar
  24. 24.
    Balentine CJ, Kenzik K, Chu DI et al (2018) Planning post-discharge destination for gastrointestinal surgery patients: room for improvement? Am J Surg 216:912–918CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • F. M. Balla
    • 1
    • 2
    Email author
  • C. G. Yheulon
    • 1
  • J. L. Stetler
    • 1
  • A. D. Patel
    • 1
  • E. Lin
    • 1
  • S. S. Davis
    • 1
  1. 1.Division of General and GI Surgery, Department of Surgery, School of MedicineEmory UniversityAtlantaUSA
  2. 2.PortlandUSA

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