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The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery.

Publication ,  Journal Article
Pierce, KE; Naessig, S; Kummer, N; Larsen, K; Ahmad, W; Passfall, L; Krol, O; Bortz, C; Alas, H; Brown, A; Diebo, B; Schoenfeld, A; Raad, M ...
Published in: Spine (Phila Pa 1976)
July 15, 2021

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: This study aimed to evaluate the utility of the modified frailty index (mFI-5) in a population of patients undergoing spine surgery. SUMMARY OF BACKGROUND DATA: The original modified frailty index (mFI-11) published as an American College of Surgeons National Surgical Quality Improvement Program 11-factor index was modified to mFI-5 after variables were removed from recent renditions. METHODS: Surgical spine patients were isolated using current procedural terminology codes. mFI-11 (11) and mFI-5 (5) were calculated from 2005 to 2012. mFI was determined by dividing the factors present by available factors. To assess correlation, Spearman rho was used. Predictive values of indices were generated by binary logistic regression. Patients were stratified into groups by mFI-5: not frail (NF, <0.3), mildly frail (MF, 0.3-0.5), severely frail (SF, >0.5). Means comparison tests analyzed frailty and clinical outcomes. RESULTS: After calculating the mFI-5 and the mFI-11, Spearman rho between the two indices was 0.926(P < 0.001). Each index established significant (all P < 0.001) predictive values for unplanned readmission (11 = odds ratio [OR]: 5.65 [2.92-10.94]; 5 = OR: 3.68 [1.85-2.32]), post-op complications (11 = OR: 8.56 [7.12-10.31]; 5 = OR: 13.32 [10.89-16.29]), and mortality (11 = OR: 41.29 [21.92-77.76]; 5 = OR: 114.82 [54.64-241.28]). Frailty categories by mFI-5 were: 83.2% NF, 15.2% MF, and 1.6% SF. From 2005 to 2016, rates of NF decreased (88.8% to 82.2%, P < 0.001), whereas MF increased (9.2% to 16.2%, P < 0.001), and SF remained constant (2% to 1.6%, P > 0.05). With increase in severity, postoperative rates of morbidities and complications increased. CONCLUSION: The five-factor National Surgical Quality Improvement Program modified frailty index is an effective predictor of postoperative events following spine surgery. Severity of frailty score by the mFI-5 was associated with increased morbidity and mortality. The mFI-5 within a surgical spine population can reliably predict post-op complications. This tool is less cumbersome than mFI-11 and relies on readily accessible variables at the time of surgical decision-making.Level of Evidence: 3.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

July 15, 2021

Volume

46

Issue

14

Start / End Page

939 / 943

Location

United States

Related Subject Headings

  • Spine
  • Retrospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Orthopedics
  • Humans
  • Frailty
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences
  • 3202 Clinical sciences
 

Citation

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Pierce, K. E., Naessig, S., Kummer, N., Larsen, K., Ahmad, W., Passfall, L., … Passias, P. G. (2021). The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery. Spine (Phila Pa 1976), 46(14), 939–943. https://doi.org/10.1097/BRS.0000000000003936
Pierce, Katherine E., Sara Naessig, Nicholas Kummer, Kylan Larsen, Waleed Ahmad, Lara Passfall, Oscar Krol, et al. “The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery.Spine (Phila Pa 1976) 46, no. 14 (July 15, 2021): 939–43. https://doi.org/10.1097/BRS.0000000000003936.
Pierce KE, Naessig S, Kummer N, Larsen K, Ahmad W, Passfall L, et al. The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery. Spine (Phila Pa 1976). 2021 Jul 15;46(14):939–43.
Pierce, Katherine E., et al. “The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery.Spine (Phila Pa 1976), vol. 46, no. 14, July 2021, pp. 939–43. Pubmed, doi:10.1097/BRS.0000000000003936.
Pierce KE, Naessig S, Kummer N, Larsen K, Ahmad W, Passfall L, Krol O, Bortz C, Alas H, Brown A, Diebo B, Schoenfeld A, Raad M, Gerling M, Vira S, Passias PG. The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery. Spine (Phila Pa 1976). 2021 Jul 15;46(14):939–943.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

July 15, 2021

Volume

46

Issue

14

Start / End Page

939 / 943

Location

United States

Related Subject Headings

  • Spine
  • Retrospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Orthopedics
  • Humans
  • Frailty
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences
  • 3202 Clinical sciences