The 5-factor modified Frailty Index (mFI-5) predicts adverse outcomes after elective Anterior Lumbar Interbody Fusion (ALIF)

Patel, Neil; Elali, Faisal; Coban, Daniel; Changoor, Stuart; Shah, Neil V.; Sinha, Kumar; Hwang, Ki Soo; Faloon, Michael; Paulino, Carl B.; Emami, Arash

doi:10.1016/j.xnsj.2022.100189

North American Spine Society Journal (NASSJ)

2023

DOI: 10.1016/j.xnsj.2022.100189

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The 5-factor modified Frailty Index (mFI-5) predicts adverse outcomes after elective Anterior Lumbar Interbody Fusion (ALIF)

Neil Patel

Faisal Elali

Daniel Coban

et al.

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2024

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Cited by 3 publications

References 32 publications

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Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study

Jain,

Goldberg,

Briggs

et al. 2024

The Laryngoscope

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ObjectiveThe modified frailty index (mFI‐5) is a National Surgical Quality Improvement Program‐derived 5‐factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI‐5 is a valid predictive measure in the transoral robotic surgery (TORS) population.MethodsRetrospective study utilizing the TriNetX US‐collaborative health records network querying for TORS patients. Cohorts were stratified by mFI‐5 score which uses five ICD‐10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI‐5 = 0.ResultsA total of 9,081 patients were included in the final analysis. Greater mFI‐5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5‐year mortality were 1.93 (p = 0.0003) for mFI‐5 = 2 and 1.90 (p = 0.0002) for mFI‐5 = 3. Odds of 2‐year mortality were 1.25 (p = 0.0125) for mFI‐5 = 1, 1.58 (p = 0.0002) for mFI‐5 = 2, and 1.87 (p = 0.003) for mFI‐5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI‐5 = 2 and 1.78 (p = 0.05) for mFI‐5 = 3. Two‐year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI‐5 = 2 and 2.84 (p < 0.0001) for mFI‐5 = 3. Two‐month odds of pneumonia were 1.50 (p = 0.0259) for mFI‐5 = 2 and 2.55 (p = 0.0037) for mFI‐5 = 3. mFI‐5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5‐year post‐TORS death (R2 = 0.99), mFI‐5 scores better predicted survival than age alone.ConclusionThis study demonstrates that mFI‐5 predicts mortality, pneumonia, and postoperative infection independently of age.Level of Evidence4 Laryngoscope, 2024

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Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study

Jain,

Goldberg,

Briggs

et al. 2024

The Laryngoscope

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The 5-Factor Modified Frailty Index is Associated With Increased Risk of Reoperations and Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion

Patel,

Coban,

Changoor

et al. 2023

Global Spine Journal

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Study Design Retrospective Cohort Study. Objectives To determine the predictive capability between the 5-factor modified frailty index (mFI-5) scores and adverse clinical and radiographic outcomes following single-level transforaminal lumbar interbody fusion (TLIF). Methods All patients over the age of 50 undergoing single-level open or minimally invasive TLIF from 2012 to 2021 with a minimum follow-up of 1 year were identified. Deformity, trauma, emergency, and tumor cases were excluded as were patients undergoing revision surgeries. An mFI-5 score was computed for each patient using a set of five factors which included hypertension requiring medication, chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, and partially or fully dependent functional status. Univariate and multivariate logistic regression analysis were performed to evaluate the impact of mFI-5 scores on readmissions, reoperations, and postoperative complications. Results 156 patients were included and grouped according to their level of frailty: no-frailty (mFI = 0, n = 67), mild frailty (mFI = 1, n = 59), and severe frailty (mFI = 2+, n = 30). Multivariate analysis found high levels of frailty (mFI = 2+) to be independent predictors of reoperation (OR: 16.9, CI: 2.7 - 106.9, P = .003) and related readmissions (OR = 16.5, CI: 2.6 - 102.7, P = .003) as compared to the no-frailty group. An mFI-5 score of 2+ was also predictive of any complication (OR = 4.5, CI: 1.4 - 14.3, P = .01) and adjacent segment disease (ASD) (OR = 12.5, CI: 1.2 - 134.0, P = .037). Conclusion High levels of frailty were predictive of related readmissions, reoperations, any complications, and ASD in older adult patients undergoing single-level TLIF.

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Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature

Manzetti,

Ruffilli,

Viroli

et al. 2024

Global Spine Journal

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Study Design Metanalysis. Objective Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI. Methods Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant. Results 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11). Conclusion This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.

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The 5-factor modified Frailty Index (mFI-5) predicts adverse outcomes after elective Anterior Lumbar Interbody Fusion (ALIF)

Cited by 3 publications

References 32 publications

Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study

Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study

The 5-Factor Modified Frailty Index is Associated With Increased Risk of Reoperations and Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion

Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature

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