Prognostic value of the 11-factor modified frailty index for early postoperative outcomes in elderly lung transplant recipients: a retrospective cohort study.

BACKGROUND: Frailty is increasingly recognized as a key determinant of surgical outcomes, yet few data describe the prognostic value of the 11-factor modified frailty index (mFI-11) in elderly lung transplant recipients. We aimed to assess the prognostic value of mFI-11 for early postoperative outcomes, including 30- and 90-day mortality and major complications in elderly lung transplant recipients. METHODS: We conducted a retrospective cohort study of patients aged ≥65 years who underwent lung transplantation at The First Affiliated Hospital of Guangzhou Medical University between September 2019 and January 2025. mFI-11 scores were calculated from 11 preoperative comorbidities/functional impairments; frailty was defined as mFI-11 ≥3. Uni- and multivariable regression models were used to examine associations between frailty and 30- and 90-day mortality, postoperative complications, and intensive care unit (ICU) hospital length of stay (LOS). RESULTS: Among 144 elderly recipients, 69 (47.9%) were frail. Frail patients had significantly higher 90-day mortality (33.33% vs. 12.0%, P=0.002) and greater incidence of septic shock, acute kidney injury (AKI), pyemia, and arrhythmia (all P≤0.004). Multivariable Cox regression showed frailty independently associated with a 2.7-fold increase in 90-day mortality [adjusted hazard ratio (HR) 2.73, 95% confidence interval (CI): 1.24-6.00, P=0.01], with preoperative extracorporeal membrane oxygenation (ECMO) use as the strongest predictor. Each 1-point increase in mFI-11 was associated with 5.19 additional ICU days of stay (β=5.19, 95% CI: 1.11-9.27, P=0.01). CONCLUSIONS: mFI-11 is a clinically significant predictor of early mortality and postoperative complications in elderly lung transplant recipients and may support risk stratification and targeted perioperative management.