Introduction/Background This study aims to evaluate the influence of surgical complexity on the occurrence of postoperative complications and mortality, considering the patient’s frailty assessed by the modified fragility index with 11 variables (mFI-11) following surgery for ovarian cancer.

Methodology Patients with advanced ovarian cancer surgically treated at the Department of Gynecology and Obstetrics, Sapienza University between January 2005 and January 2023 were included. A surgical complexity score was used to assess the extent of surgery and the mFI-11 was calculated. Data were evaluated with appropriate statistical analysis.

Results This study of 336 patients revealed a 29% incidence of at least one postoperative complication, with a 4.9% prevalence of severe complications (G3-G5). Body mass index (BMI)≥ 30 (p=0.03), elevated modified fragility index (mFI) score (p=0.04) and high-complexity surgery (p<0.001) independently predicted the occurrence of severe complications. Patients with a mFI≥ 3, undergoing intermediate or high-complexity surgeries had an increased risk of severe complications, ranging from 27% to 48%.

Conclusion The integrated assessment of the modified frailty index (mFI) and anticipated surgical complexity offers the potential to identify patients predisposed to severe postoperative morbidity, enabling the stratification of individuals less likely to withstand complex surgical interventions.

Disclosures None.