Modified Frailty Index predicts postoperative complications following adult-acquired buried penis surgery: A retrospective cohort study

Abstract

Given that patients with morbid obesity are predisposed to frailty, we sought to determine whether the 5-Factor Modified Frailty Index (mFI-5) predicts postoperative complications following surgery for adult-acquired buried penis, and secondarily, to compare the mFI-5 to body mass index (BMI) and American Society of Anesthesiologists (ASA) status as preoperative risk stratification measures. We included all patients who underwent surgical management for adult-acquired buried penis at an academic Level I trauma center between 2015 and 2023. A manual chart review was performed to collect data on patient demographics, modified frailty index variables, intraoperative data, postoperative outcomes, and complications. A total of 55 patients underwent surgical repair of adult-acquired buried penis, with 26 experiencing postoperative complications (47.3%). Univariable regression analyses revealed that the mFI-5 was a significant predictor of postoperative complications (odds ratio [OR] 3.40, 95% confidence interval [CI]: 1.56-7.42, p=.002), ongoing postoperative urinary problems (OR 2.03, 95% CI: 1.02-4.05, p=.045), patient dissatisfaction with outcomes (OR 3.29, 95% CI: 1.35-8.02, p=.009), and persistent postoperative symptoms (OR 2.42, 95% CI: 1.10-5.35, p=.029). There was no significant association between ASA classification and postoperative complications (OR 1.59, 95% CI:.544-4.63, p=.398). Multivariable analysis demonstrated that the mFI-5 was an independent predictor of postoperative complications (OR 5.34, 95% CI: 1.80-15.9, p=.003) when controlling for BMI and age. The mFI-5 is an independent predictor of postoperative complications in patients undergoing surgical repair of adult-acquired buried penis. The simplicity of the index permits efficient preoperative risk stratification of adult-acquired buried penis patients and provides important counseling information that may not be reflected by age or BMI alone.