CHICAGO—Frailty, which has long been considered a predictor of complications in major surgery, may not adversely affect short-term outcomes or recurrence rates after complex abdominal wall reconstruction, according to findings presented at the 2025 Clinical Congress of the American College of Surgeons.
The results challenge assumptions about operative risk in this population and support a more nuanced approach to patient selection and counseling.
“As frailty has moved from being a loose clinical judgment to something measurable, the field has made efforts to bring more consistency to how it’s assessed,” said Viemma Nwigwe, MD, a postdoctoral research fellow in general surgery at NewYork-Presbyterian Hospital, in New York City. “Even though the Modified Frailty Index [mFI] has been studied across a range of surgical specialties, there is still limited data on how it performs in complex abdominal wall reconstruction, which tends to involve higher-risk patients. We wanted to clarify this relationship and help surgeons make more tailored, better-informed decisions for this population.”
In the retrospective study of 185 complex abdominal wall cases performed between 2020 and 2024, patients were stratified using the ACS National Surgical Quality Improvement Program 5-Factor mFI. Forty-seven patients (25%) met the criteria for frailty (mFI, =2).
As expected, frail patients had significantly higher rates of comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, and congestive heart failure. However, the groups were similar in hernia defect size, body mass index, functional status, and follow-up duration.
Of note, frailty was not associated with worse postoperative outcomes. Recurrence rates were comparable between frail and non-frail patients (2.9% vs. 2.1%), and surgical site morbidity—such as infection, seroma, and hematoma—did not significantly differ. A propensity score analysis confirmed that frailty did not independently predict recurrence or complication risk.
“Frailty should not exclude patients from [complex abdominal wall reconstruction], but rather guide preoperative risk stratification and counseling,” Dr. Nwigwe said.
Dr. Nwigwe noted that the results raise additional questions for future research.
“There is a need to define and develop optimal perioperative management strategies specifically tailored to mitigate patient frailty in evaluation for procedure and postoperative outcomes,” she said. “Prospective studies are also needed to rigorously evaluate the efficacy of targeted prehabilitation programs in improving outcomes for frail patients.”