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Predicting outcomes of breast-conserving surgery in patients with breast cancer using the modified 5-Item frailty index: a retrospective cohort study

Background. Breast cancer is the most common malignancy among women worldwide, with breast-conserving surgery (BCS) being a key treatment. The modified 5-item frailty index (mFI-5), a well-validated tool for assessing frailty, has shown predictive utility in other surgical contexts but remains under...

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Main Authors: Knoedler, Samuel (Author) , Jiang, Jun (Author) , Moog, Philipp (Author) , Wirtz, Julius M. (Author) , Schaschinger, Thomas (Author) , Mayer, Horacio (Author) , Machens, Hans-Guenther (Author) , Könneker, Sören (Author) , Hundeshagen, Gabriel (Author) , Kim, Bong-Sung (Author) , Orgill, Dennis P. (Author) , Panayi, Adriana C. (Author)
Format: Article (Journal)
Language:English
Published: 16 May 2025
In: Annals of surgical oncology
Year: 2025, Volume: 32, Issue: 8, Pages: 5528-5539
ISSN:1534-4681
DOI:10.1245/s10434-025-17438-y
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1245/s10434-025-17438-y
Verlag, kostenfrei, Volltext: https://link.springer.com/article/10.1245/s10434-025-17438-y
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Author Notes:Samuel Knoedler, Jun Jiang, MD, PhD, Philipp Moog, MD, PhD, Julius M. Wirtz, Thomas Schaschinger, Horacio Mayer, MD, PhD, Hans-Guenther Machens, MD, PhD, Sören Könneker, MD, PhD, Gabriel Hundeshagen, MD. PhD, MMS, Bong-Sung Kim, MD, PhD, MBA, Dennis P. Orgill, MD, PhD, and Adriana C. Panayi, MD, PhD
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Summary:Background. Breast cancer is the most common malignancy among women worldwide, with breast-conserving surgery (BCS) being a key treatment. The modified 5-item frailty index (mFI-5), a well-validated tool for assessing frailty, has shown predictive utility in other surgical contexts but remains under-explored in BCS. Patients and Methods. Using the American College of Surgeons National Surgical Quality Improvement Program database (2008–2021), we identified adult female patients with breast cancer who underwent BCS. Frailty was assessed using the mFI-5 and scored from 0 to 5, with higher scores indicating greater frailty. Multivariable logistic regression was employed to evaluate associations between mFI-5 scores and postoperative outcomes. Results. A total of 96,586 patients were included. Higher mFI-5 scores were significantly associated with older age, higher body mass index (BMI), and increased ASA scores. Multivariate analysis showed greater frailty was linked to higher risks of any (mFI = 1: OR 1.06; mFI = 2: OR 1.26; mFI ≥ 3: OR 2.45), surgical (mFI = 1: OR 1.18; mFI = 2: OR 1.65; mFI ≥ 3: OR 3.17), and medical complications (mFI = 1: OR 1.72; mFI = 2: OR 2.56; mFI ≥ 3: OR 6.05). Similarly, frail patients had significantly higher odds of mortality (mFI = 1: OR 2.27; mFI = 2: OR 4.3; mFI ≥ 3: OR 11.05) and unplanned readmission (mFI = 1: OR 1.38; mFI = 2: OR 2.25; mFI ≥ 3: OR 6.05). Reoperation risk decreased with higher mFI-5 scores (mFI = 1: OR 0.92; mFI = 2: OR 0.73; mFI ≥ 3: OR 0.92). Conclusions. The mFI-5 is strongly associated with postoperative outcomes after BCS and serves as a valuable tool for risk stratification. Our findings reinforce its role as a critical preoperative index to identify high-risk patients and guide surgical planning.
Item Description:Gesehen am 04.11.2025
Physical Description:Online Resource
ISSN:1534-4681
DOI:10.1245/s10434-025-17438-y

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