The 5-Factor Modified Frailty Index as a Predictor of Post-operative Complications in Males Undergoing Mastectomy : MFI-5 and Post-Mastectomy Complications in Males

Parhom Towfighi; Romina Deldar; Gina Cach; Olutayo Sogunro; Kenneth Fan; David Song

doi:10.32768/abc.202310174-80

Parhom Towfighi ⁽¹⁾, Romina Deldar ⁽²⁾, Gina Cach ⁽³⁾, Olutayo Sogunro ⁽⁴⁾, Kenneth Fan ⁽⁵⁾, David Song ⁽⁶⁾

(1) Georgetown University School of Medicine, Washington DC, USA, United States,

(2) Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington DC, USA , United States,

(3) Georgetown University School of Medicine, Washington DC, USA , United States,

(4) Department of General Surgery, MedStar Georgetown University Hospital, Washington DC, USA , United States,

(5) Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington DC, USA , United States,

(6) Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington DC, USA , United States

https://doi.org/10.32768/abc.202310174-80

Issue
Vol. 10 No. 1 (2023): Volume 10, issue 1, February 2023

Submitted
December 13, 2022

Published
December 27, 2022

Keywords:

Mastectomy, Male breast cancer, health status index, morbidity, Complications.

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Abstract

Introduction: The modified five-item frailty index (mFI-5) is a valuable tool for preoperative risk stratification of patients. There is a paucity of literature regarding the use of the mFI-5 in regard to males undergoing mastectomy. The aim of this study was to determine if the mFI-5 can predict negative postoperative outcomes.

Methods: The 2005-2016 NSQIP database was queried to identify males aged 60 or older who underwent total mastectomy. Patient demographics, comorbidities, perioperative factors, and postoperative complications were collected. Patients were divided into cohorts based on whether their mFI-5 score was <2 or >2. Primary outcomes included prolonged postoperative length of stay (LOS), defined as greater than 75^th percentile of the study population, and postoperative complications.

Results: A total of 1,251 patients were identified, of which 958 patients (76.6%) had mFI-5 scores <2 and 293 patients (23.4%) had mFI-5 scores >2. A significantly higher prevalence of medical complications occurred in the higher mFI group (6.1% vs. 1.6%, p<0.001). The mFI-5 was an independent risk factor for postoperative medical complications (OR 2.70, 95% CI, 1.28-5.68, p=0.009).

Conclusion: This is the first study to evaluate the utility of mFI in predicting postoperative complications in males undergoing total mastectomies. We demonstrate that mFI has utility and is applicable as a risk stratification tool for males undergoing mastectomy.

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References

65 and Older Population Grows Rapidly as Baby Boomers Age. United States Census Bureau. Accessed May 17, 2022, Available from: https://www.census.gov/newsroom/press-releases/2020/65-older-population-grows.html

Seib CD, Rochefort H, Chomsky-Higgins K, Gosnell JE, Suh I, Shen WT, et al. Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations. JAMA Surg. Feb 1 2018;153(2):160-168. doi: 10.1001/jamasurg.2017.4007.

Wang F, Shu X, Meszoely I, Pal T, Mayer IA, Yu Z, et al. Overall Mortality After Diagnosis of Breast Cancer in Men vs Women. JAMA Oncol. Nov 1 2019;5(11):1589-1596. doi: 10.1001/jamaoncol.2019.2803.

Nuzzi LC, Firriolo JM, Pike CM, Cerrato F, DiVasta AD, Labow BI. The Effect of Surgical Treatment for Gynecomastia on Quality of Life in Adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2018;63 6:759-765.

Fricke A, Lehner GM, Stark GB, Penna V. Long-Term Follow-up of Recurrence and Patient Satisfaction After Surgical Treatment of Gynecomastia. Aesthetic Plast Surg. Jun 2017;41(3):491-498. doi: 10.1007/s00266-017-0827-x.

Cuccolo NG, Kang CO, Boskey ER, Ibrahim AMS, Blankensteijn LL, Taghinia A, et al. Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes. Plastic and Reconstructive Surgery – Global Open. 2019;7(6):e2316. doi: 10.1097/gox.0000000000002316.

Ammari T, Sluiter EC, Gast K, Kuzon WM, Jr. Female-to-Male Gender-Affirming Chest Reconstruction Surgery. Aesthet Surg J. Jan 17 2019;39(2):150-163. doi: 10.1093/asj/sjy098.

Clark K. American Society of Plastic Surgeons releases first-ever facial, breast/chest and genital data for gender affirmation procedures. American Society of Plastic Surgeons. Accessed May 17, 2022, Available from: https://www.plasticsurgery.org/news/articles/american-society-of-plastic-surgeons-releases-first-ever-facial-breast/chest-and-genital-data-for-gender-affirmation-procedures

Nolan IT, Dy GW, Levitt N. Considerations in Gender-Affirming Surgery: Demographic Trends. Urol Clin North Am. Nov 2019;46(4):459-465. doi: 10.1016/j.ucl.2019.07.004.

Poh AWY, Teo SP. Utility of Frailty Screening Tools in Older Surgical Patients. Ann Geriatr Med Res. 6 2020;24(2):75-82. doi: 10.4235/agmr.20.0023.

Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med. May 2010;26(2):275-86. doi: 10.1016/j.cger.2010.02.002.

Weaver DJ, Malik AT, Jain N, Yu E, Kim J, Khan SN. The Modified 5-Item Frailty Index: A Concise and Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity Following Elective Posterior Lumbar Fusions. World Neurosurgery. 2019/04/01/ 2019;124:e626-e632. doi: 10.1016/j.wneu.2018.12.168.

Cuccolo NG, Sparenberg S, Ibrahim AMS, Crystal DT, Blankensteijn LL, Lin SJ. Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases(†). J Plast Surg Hand Surg. Apr 2020;54(2):67-76. doi: 10.1080/2000656x.2019.1688166.

Song X, Mitnitski A, Rockwood K. Prevalence and 10-Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation. Journal of the American Geriatrics Society. 2010;58(4):681-687. doi: 10.1111/j.1532-5415.2010.02764.x.

Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data. Journal of the American College of Surgeons. 2018;226(2)

Jain NS, Vuong LN, Hickman LB, Chin P, Hill EJR, Buck D 2nd, et al. Using the modified frailty index to predict negative outcomes in free-flap breast reconstruction: A National Surgical Quality Improvement Project-based study. Microsurgery. Nov 2021;41(8):709-715. doi: 10.1002/micr.30810.

Hermiz SJR, Lauzon S, Brown G, Herrera FA. Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Breast Reconstruction. Ann Plast Surg. Jun 1 2021;86(6S Suppl 5):S615-s621. doi: 10.1097/sap.0000000000002765.

Magno-Pardon DA, Luo J, Carter GC, Agarwal JP, Kwok AC. An Analysis of the Modified Five-Item Frailty Index for Predicting Complications following Free Flap Breast Reconstruction. Plast Reconstr Surg. Jan 1 2022;149(1):41-47. doi: 10.1097/prs.0000000000008634.

Dammeyer K, Alfonso AR, Diep GK, Kantar RS, Berman ZP, Daar DA, et al. Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5-factor frailty index. Breast J. Jun 2021;27(6):509-513. doi: 10.1111/tbj.14208.

Al-Taki M, Sukkarieh HG, Hoballah JJ, Jamali SF, Habbal M, Masrouha KZ, et al. Effect of Gender on Postoperative Morbidity and Mortality Outcomes: A Retrospective Cohort Study. Am Surg. Mar 1 2018;84(3):377-386.

Heyer JH, Cao NA, Amdur RL, Rao RR. Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women? Int J Spine Surg. Apr 2019;13(2):125-131. doi: 10.14444/6017.

Mousapour P, Tasdighi E, Khalaj A, Mahdavi M, Valizadeh M, Taheri H, et al. Sex disparity in laparoscopic bariatric surgery outcomes: a matched-pair cohort analysis. Sci Rep. Jun 17 2021;11(1):12809. doi: 10.1038/s41598-021-92254-4.

Eck DL, Koonce SL, Goldberg RF, Bagaria S, Gibson T, Bowers SP, et al. Breast surgery outcomes as quality measures according to the NSQIP database. Ann Surg Oncol. Oct 2012;19(10):3212-7. doi: 10.1245/s10434-012-2529-6.

American Medical Association. Surgery: Integumentary system. CPT Assistant Newsletter; 2007;17(12):7.

American Medical Association. . Coding brief: Coding for breast surgery. CPT Assistant Newsletter; 2015;25(3):5, 11.

Lee J, Alfonso AR, Kantar RS, Diep GK, Berman ZP, Ramly EP, et al. Modified Frailty Index Predicts Postoperative Complications following Panniculectomy in the Elderly. Plast Reconstr Surg Glob Open. Jul 2020;8(7):e2987. doi: 10.1097/gox.0000000000002987.

Chimukangara M, Helm MC, Frelich MJ, Bosler ME, Rein LE, Szabo A, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surgical Endoscopy. 2017/06/01 2017;31(6):2509-2519. doi: 10.1007/s00464-016-5253-7.

Segal DN, Wilson JM, Staley C, Michael KW. The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation. World Neurosurg. Aug 2018;116:e225-e231. doi: 10.1016/j.wneu.2018.04.172.

Yagi M, Michikawa T, Hosogane N, Fujita N, Okada E, Suzuki S, et al. The 5-Item Modified Frailty Index Is Predictive of Severe Adverse Events in Patients Undergoing Surgery for Adult Spinal Deformity. Spine. 2019;44(18):E1083-E1091. doi: 10.1097/brs.0000000000003063.

Hackett NJ, De Oliveira GS, Jain UK, Kim JY. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. Jun 2015;18:184-90. doi: 10.1016/j.ijsu.2015.04.079.

Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. Apr 12 2017;4(4):Cd001431. doi: 10.1002/14651858.CD001431.pub5.

Deldar R, Sayyed AA, Towfighi P, Aminpour N, Sogunro O, Son JD, et al. Postmastectomy Reconstruction in Male Breast Cancer. The Breast Journal. 2022/03/29 2022;2022:5482261. doi: 10.1155/2022/5482261.

Friedman S, Floyd C, Chrysopoulo M. Men can have breast reconstruction after mastectomy. Facing Our Risk of Cancer Empowered, Inc. Accessed February 17, 2022, Available from: https://www.facingourrisk.org/blog/men-can-have-breast-reconstruction-after-mastectomy

Al-Kalla T, Komorowska-Timek E. Breast total male breast reconstruction with fat grafting. Plast Reconstr Surg Glob Open. Nov 2014;2(11):e257. doi: 10.1097/gox.0000000000000221.

Bamba R, Krishnan NM, Youn R, Economides JM, Pittman TA. The Use of Low-Profile Silicone Breast Implants in Male Breast Reconstruction. Plast Reconstr Surg. Feb 2018;141(2):324e-325e. doi: 10.1097/prs.0000000000004089.

Giunta G, Rossi M, Toia F, Rinaldi G, Cordova A. Male breast cancer: Modified radical mastectomy or breast conservation surgery? A case report and review of the literature. Int J Surg Case Rep. 2017;30:89-92. doi: 10.1016/j.ijscr.2016.11.030.

Schaverien MV, Scott JR, Doughty JC. Male mastectomy: an oncoplastic solution to improve aesthetic appearance. J Plast Reconstr Aesthet Surg. Dec 2013;66(12):1777-9. doi: 10.1016/j.bjps.2013.04.039.

Spear SL, Bowen DG. Breast reconstruction in a male with a transverse rectus abdominis flap. Plast Reconstr Surg. Oct 1998;102(5):1615-7. doi: 10.1097/00006534-199810000-00043.

Alluri RK, Leland H, Heckmann N. Surgical research using national databases. Ann Transl Med. Oct 2016;4(20):393. doi: 10.21037/atm.2016.10.49.

Authors

Parhom Towfighi

Georgetown University School of Medicine, Washington DC, USA

https://orcid.org/0000-0003-2192-1143

parhomtowfighi@gmail.com (Primary Contact)

Romina Deldar

Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington DC, USA

https://orcid.org/0000-0003-4551-7436

Gina Cach

Georgetown University School of Medicine, Washington DC, USA

https://orcid.org/0000-0003-2703-5791

Olutayo Sogunro

Department of General Surgery, MedStar Georgetown University Hospital, Washington DC, USA

https://orcid.org/0000-0002-2979-3628

Kenneth Fan

Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington DC, USA

https://orcid.org/0000-0001-5951-5576

David Song

Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington DC, USA

https://orcid.org/0000-0001-8064-1534

Towfighi P, Deldar R, Cach G, Sogunro O, Fan K, Song D. The 5-Factor Modified Frailty Index as a Predictor of Post-operative Complications in Males Undergoing Mastectomy : MFI-5 and Post-Mastectomy Complications in Males . Arch Breast Cancer [Internet]. 2022 Dec. 27 [cited 2024 May 19];10(1):74-80. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/656

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INTRODUCTION

The proportion of the United States population aged 60 and older has continued to rise. As of 2020, the population over the age of 65 grew by one-third since 2010. 1 With life expectancy increasing in the setting of a growing older adult population, surgeons will inevitably encounter more older adult patients and should increasingly be attentive to the needs of this population to provide safe and specialized treatment. 1 While the incidence of total mastectomy in women for the treatment of breast cancer is slowly decreasing given the widespread usage of neoadjuvant chemotherapy, mastectomy in males is commonly performed for several indications, including breast cancer, gynecomastia, and genderaffirming surgery. Mastectomy is commonly performed for male breast cancer, which has been increasing in incidence in recent years. 2 It has also been shown to have psychological benefits in those

Original Article

Open Access who have symptomatic gynecomastia, which is estimated to affect up to 60% of older men. 3 4 Furthermore, there has been a rising demand for mastectomy for gender-affirming surgery (GAS) in recent years, which accounts for approximately 15% of male mastectomies. 5 6 According to the American Society of Plastic Surgeons, there was a 289% increase in GAS among transgender men between 2016 and 2017, and a 15% increase in transgender men pursuing chest surgery between 2019 and 2020. 7 8 Given the prevalence of gynecomastia in older men, the rise in rates of GAS, and the increasing life expectancy among the United States population, it is likely that the number of mastectomies performed in older males will also increase. Prior to mastectomy, as with any surgical procedure, preoperative risk stratification is essential to determine whether a patient is a suitable candidate for surgery. 9 Frailty is an overall measure of a patient's comorbidity burden and is assessed via a multisystem approach. 10 11 Studies have shown that frailty can effectively predict adverse postoperative outcomes, such as complications and mortality, superior to the predictive value of age alone. 9 12 13 Several frailty indices exist, including the 11-factor modified frailty index (mFI-11), which uses 11 preoperative variables in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. 11 14 Lately, the 5-factor modified frailty index (mFI-5) has been increasingly used, with studies demonstrating that the mFI-5 is as efficacious as the mFI-11 in predicting negative outcomes across many surgical subspecialties. 14 The mFI-5 uses a fivepoint scale that has been shown to positively correlate with a patient's overall frailty. 14 The presence of each variable contributes one point to a patient's overall score: COPD or recent pneumonia, congestive heart failure, non-independent functional status, hypertension requiring medication, and diabetes mellitus. The utility of the newer mFI-5 index versus its 11-factor predecessor comes from its ability to be quickly calculated using patient history alone instead of having trained personnel assess the other variables (i.e., impaired sensorium, ischemic rest pain, functional neurological deficits, etc.). 14 The mFI-5 has previously been validated as an effective risk stratification tool for females undergoing mastectomy and breast reconstruction. 15 16 17 18 However, no studies have evaluated the utility of the mFI-5 in males undergoing mastectomy, and the results of previous studies in female patients may not be reproducible in male patients. 19 20 21 Therefore, the aim of this study is to determine if the mFI-5 can accurately predict postoperative complications in males undergoing mastectomy, which may impact clinical decision making, such as the choice to undergo reconstruction.

METHODS

The 2005 to 2016 ACS NSQIP database was queried to identify male patients aged 60 years and older who underwent total mastectomy. NSQIP is a risk-adjusted data collection mechanism designed to enable hospitals to benchmark quality initiatives by capturing uniform preoperative risk factors and intraoperative variables for surgical patients and tracks 30-day postoperative complications. 22 Because of the inherent limitations of the NSQIP database, it is not possible to infer the sex of the patient during a mastectomy for GAS, and thus all patients listed as male in the database were included in this study. Men who underwent mastectomy were identified using year-appropriate Current Procedural terminology (CPT) codes: simple mastectomy (CPT 19303); skin-sparing mastectomy (CPT 19304); radical mastectomy (CPT 19305); mastectomy, radical, urban type (CPT 19306); mastectomy, modified radical (CPT 19307). While there has been previous misreporting of CPT code 19304 as a subcutaneous mastectomy, when it was intended to have been coded as skin-sparing mastectomy, we include this code in our analysis to be inclusive of all males who underwent any type of mastectomy. 23 24 Patients who underwent any other concurrent procedure unrelated to their breast surgery were excluded. Patients who underwent partial mastectomy were also excluded.

Data regarding patient demographics, medical comorbidities, perioperative factors, and postoperative complications was collected. Of note, while race was a captured data point, only White, Black, and Asians were analyzed statistically either due to the low number of individuals in other races (e.g., American-Indian/Alaskan, Native Hawaiin/Pacific Island) or due to lack of data on race for certain patients. Additionally, due to the limitations of the NSQIP database, specific details on the timing of post-operative reconstruction (e.g., immediate, delayed-immediate, delayed) after mastectomy are lacking. Surgical complications were defined as superficial surgical site infections, deep wound infections, organ space infections, wound dehiscence, and return to the operating room. Medical complications were defined as pneumonia, unplanned reintubation, failure to wean off ventilation, progressive renal insufficiency, acute renal failure, venous thromboembolism, urinary tract infection, stroke, bleeding requiring transfusion, myocardial infarction, sepsis, and cardiac arrest. A mFI-5 score was calculated for each patient based on the presence of diabetes, hypertension, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or pneumonia within 30 days of surgery, and dependent functional status, with scores ranging from 0 to 5. Patients were stratified into cohorts based on whether their mFI-5 score was <2 or >2. We used a threshold mFI-5 score of >2 based on the precedent set in previous studies that evaluated the predictive value of mFI-5 for postoperative morbidity in various surgical specialties. 11 BMI and ASA class were also independent risk factors for postoperative medical complications. Frailty was not an independent risk factor for prolonged postoperative length of stay, while ASA class was an independent risk factor for prolonged postoperative LOS (Tables 3 and 4).

DISCUSSION

This is the first study to evaluate the utility of mFI in predicting postoperative complications in males undergoing total mastectomies. Males undergoing mastectomy are much less studied than their female counterparts, and tools that may aid physician decision making and mitigate complications in at-risk patients are imperative. Our results demonstrate that an mFI score ≥2 is associated with a higher rate of postoperative medical complications in males undergoing mastectomy. Patients with increased frailty also had significantly higher BMI and a higher prevalence of patients on chronic steroid medication, both of which could potentially confound the results observed. Additionally, patients with a higher ASA classification (class 3 and 4), a preoperative factor that has been shown to be associated with higher perioperative risk, 25 were more likely to have mFI scores ≥2, while those with lower ASA classes (class 1 and 2) tended to have mFI scores ≤2. The mFI-5 was found to be an independent risk factor for postoperative medical complications (OR 2.70, P=0.009) when multivariate regression analysis was performed to account for BMI, steroid use, ASA class and race in males undergoing mastectomy. This finding provides further evidence that the mFI tool is a better predictive tool for morbidity than using age alone in the male mastectomy population. While BMI and ASA class were also independent risk factors for postoperative medical complications, the frailty index provides the strongest odds ratio of 2.70.

Dammeyer et al. investigated the use of the mFI-5 in females undergoing mastectomy using the NSQIP database and found that an mFI-5 ≥2 was associated with increased postoperative complications. 18 However, we found that mFI-5 was not independently predictive of postoperative surgical complications, a finding which contradicts the findings of the aforementioned study. 18 While this non-concordant finding between males and females is not entirely clear, the mFI-5 remains an important risk stratification tool to help predict postoperative complications and to aid in shared decision-making between patients and physicians. 26 The data in this study present an important discussion point on the usage of risk stratification tools for predictive postoperative complications. Because frailty is associated with higher postoperative medical complications, physicians can recognize that performing total mastectomy in males with breast cancer presents with the same risks of performing surgery on any frail population. Thus, when facing the choice of performing total mastectomy in this population, surgeons can focus on medical optimization in their patients rather than other specific risk factors.

Moreover, a patient's frailty was not associated with postoperative surgical complications, which further provides evidence that a patient with higher frailty is inherently at higher risk of medical complications after surgery, an unsurprising fact. While the mFI-5 is helpful in determining the risk of complications, it should be noted that its use is not uniquely tied to the male breast cancer population, but further provides data supporting the use of frailty as a quick tool to assess the risk of surgery in high-risk patients.

Of note, there was no difference in rates of postoperative complications following breast reconstruction between mFI-5 groups. Male breast reconstruction after mastectomy is rare, and data is scarce on this subject. 27 Despite federal law mandating that physicians discuss breast reconstruction with all patients undergoing mastectomy, this is rarely done with males compared to females. 28 Given that postoperative complications following reconstruction was similar between frailty cohorts, we advocate that surgeons should offer breast reconstruction to all males undergoing mastectomy as post-mastectomy reconstruction is associated with increased quality of life in both males and females. 29 30 31 32 33 While the NSQIP database provides insightful information, our study is not without limitations. The NSQIP database only provides data on 30-day morbidity, and thus our values are likely an underreported representation of the real population. Other limitations of the database include previously cited pitfalls of NSQIP, such as the lack of specific surgical indications, outcomes of a given procedure, and disproportionate inclusion of data from large teaching hospitals. 34 Additionally, there are likely more factors that influence morbidity, such as insurance and socioeconomic status, that are not captured in the NSQIP database. Also, as stated in our methods, we could not determine the sex of the patient during a mastectomy for gender-affirming surgery, and thus all patients listed as male in the database were included in the study.

CONCLUSION

As mastectomy in males is commonly performed, perioperative risk stratification is an effective tool to predict postoperative morbidity in this population. We demonstrated that mFI-5 is a useful predictor of 30-day postoperative medical complications in males undergoing total mastectomy. It should be used with the understanding that medically high-risk patients overall are inherently at risk of surgical complications and that this specific population is not an exception.

ACKNOWLEDGEMENTS

We would like to thank all the authors for their thoughtful contributions to the design and implementation of this study.

CONFLICTS OF INTEREST

There are no conflicts of interest to report for any of the authors.

FUNDING

There are no financial disclosures, commercial associations, or any other conditions to report.

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The 5-Factor Modified Frailty Index as a Predictor of Post-operative Complications in Males Undergoing Mastectomy MFI-5 and Post-Mastectomy Complications in Males

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