FRAIL scale as a predictor of complications and mortality in older patients undergoing reconstructive surgery for non-melanoma skin cancer

The aim of the present study was to determine the association between preoperative frailty and the onset of surgical complications in patients diagnosed with massive non-melanoma skin cancer subjected to plastic and reconstructive surgery. A retrospective analysis was performed on a cohort of 587 patients with non-melanoma skin cancer, selected on the basis of specific inclusion criteria, who were subjected to plastic and reconstructive surgery between 2005 and 2014. Frailty was scored using the FRAIL index, whereas postoperative complications were classified according to Clavien-Dindo criteria. By binary logistic regression, the odds and probabilities of complications were calculated as a function of increasing values of the FRAIL index. Two different logistic models were created, comparing absent/mild (Clavien grades 1st and 2nd) vs. moderate/severe complications or mortality (Clavien grades 3rd-5th; model A), or absent/mild/moderate complications (Clavien grades 1st-3rd) vs. severe complications or mortality (Clavien grades 4th and 5th; model B). The FRAIL index was an accurate predictor of surgical complications or mortality, with significant odds ratios and goodness of fit. In model A, FRAIL scores 4 and 5 were the most critical predictors of moderate/severe complications or mortality (37 and 94% probability, 0.6 and 17.3 odds, respectively), compared to score 3 (2% probability, 0.02 odds) or lower. In model B, FRAIL score 5 was the most critical predictor of severe complications or mortality, as it was associated with a 74.6% probability and 2.93 odds for these events. In conclusion, increasing FRAIL scores were associated with worsening surgical outcomes for patients with non-melanoma skin cancer undergoing plastic/reconstructive surgery. A low rate of surgical complications was observed in pre-frail and frail patients up to FRAIL score 3.