To study the relationship between 5-item modified frailty index (5i-mFI) and short-term complications, 30-day mortality and prognosis of pancreaticoduodenectomy (PD).

The data of 269 patients who underwent PD in the First Affiliated Hospital of Bengbu Medical College from March 2017 to October 2022 were retrospectively collected. According to the scores of 5 variables including hypertension, diabetes, chronic obstructive pulmonary disease, congestive heart failure and dependent functional status, 5i-mFI score was performed. The patients were divided into non-frail group (0 or 1 point) and frail group (≥2 points) by 5i-mFI score. The relationship between 5i-mFI score and short-term complications and death within 30 days after PD was discussed. The area under the curve (AUC) was used to determine the ability of 5i-mFI score to identify recent postoperative complications.

55 cases (20.4%) were included in the frailty group and 214 cases (79.6%) were included in the non-frailty group. The mild complications, major complications, any complications and mortality within 30 days after operation in the frailty group were significantly higher than those in the non-frailty group, and the probability increased gradually with the increase of 5i-mFI score, the differences were statistically significant (all P<0.01). The incidence of postoperative complications such as grade B/C pancreatic fistula, gastric emptying disorder, chylous leakage, bile leakage, pulmonary complications, cardiac complications, and deep vein thrombosis was higher in the frailty group (P<0.05). The AUC of 5i-mFI score for predicting short-term complications after PD was 0.843 (standard error =0.03, 95% CI: 0.784-0.903, P<0.01), with good accuracy.

Compared with non-frail patients, frail patients with 5i-mFI≥ 2 points have higher probability of postoperative complications and 30-day mortality. The 5i-mFI score has certain predictive value for short-term complications and 30-day mortality after PD, which is helpful for clinical decision-making.