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

Weaver, D. L.; Malik, Azeem Tariq; Jain, Nikhil; Yu, Elizabeth; Kim, Jeffery; Khan, Safdar N.

doi:10.1016/j.wneu.2018.12.168

Cited by 159 publications

(102 citation statements)

References 27 publications

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“…6 Beyond this, the mFI has been further abbreviated to the 5-variable mFI and has been shown to predict postoperative morbidity following posterior lumbar fusion surgery. 23 Consistent with a number of previously reported studies, 3,6-8 our findings suggest that the 11-variable mFI has utility in stratifying the 80 years and older subpopulation into low and high risk according to a threshold score of 3 variables (0.27). We observed that the mFI of 3 variables (0.27) was strongly associated with an increased risk of complications, surgical site infection, and mortality.…”

Section: Discussionsupporting

confidence: 91%

Spinal Surgery in Patients Aged 80 Years and Older: Risk Stratification Using the Modified Frailty Index

Kweh

Lee

Tan

et al. 2020

Global Spine Journal

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Study Design: This was an ambispective clinical quality registry study. Objective: To evaluate utility of 11-variable modified Frailty Index (mFI) in predicting postoperative outcomes among patients ≥80 years undergoing spinal surgery. Methods: Consecutive patients ≥80 years who underwent spinal surgery between January 1, 2013, and June 30, 2018, were included. Primary outcome measure was rate of major complication. Secondary outcome measures were (1) overall complication rate, (2) surgical site infection, and (3) 6-month mortality. Results: A total of 121 operations were performed. Demographic metrics were (1) age (mean ± SD) = 83.1 ± 2.8 years and (2) mFI (mean ± SD) = 2.1 ± 1.4 variables. As mFI increased from 0 to ≥4 variables, risk of major complication increased from 18.2% to 40.0% ( P = .014); overall complication increased from 45.5% to 70.0% ( P = .032); surgical site infection increased from 0.0% to 25.0% ( P = .007). There were no significant changes in risk of 6-month mortality across mFIs ( P = .115). Multivariate analysis showed that a higher mFI score of ≥3 variables was associated with a significantly higher risk of (1) major complication ( P = .025); (2) overall complication ( P = .015); (3) surgical site infection ( P = .007); and (4) mortality ( P = .044). Conclusions: mFI scores of ≥3/11 variables were associated with a higher risk of postoperative morbidity in patients aged ≥80 years undergoing spinal surgery. The mFI-associated risk stratification provides a valuable adjunct in surgical decision making for this rapidly growing subpopulation of patients.

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Section: Discussionsupporting

confidence: 91%

Spinal Surgery in Patients Aged 80 Years and Older: Risk Stratification Using the Modified Frailty Index

Kweh

Lee

Tan

et al. 2020

Global Spine Journal

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“…As evidenced in our results, increasing age was associated with an additional $1,600 to $3,400 in 90-day costs, even after adjusting for differences in the comorbidity burden seen between different age brackets. This is to be expected, as the functional decline and/or increasing frailty [26,27] associated with advancing age may warrant a higher level of rehabilitative care for these patients, to ensure return to baseline activity levels. The lack of risk-adjustment of payments may actually prevent elderly patients from getting quality postoperative care and rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Are current DRG-based bundled payment models for lumbar fusions risk-adjusting adequately? An analysis of Medicare beneficiaries

Malik

Phillips

et al. 2020

The Spine Journal

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“…[ 3 , 8 ] Multiple additional risk factors associated with frailty scores also contributed to poorer outcomes/increased postoperative adverse events; UTI and return to the operating room (e.g., over a two-fold increased odds of a prolonged LOS). [ 9 ] Previous series also noted that performing surgeries at major, high-volume spine center may minimize reoperations.…”

Section: Discussionmentioning

confidence: 99%

Prolonged length of stay and discharge disposition to rehabilitation facilities following single-level posterior lumbar interbody fusion for acquired spondylolisthesis

Benton

Ramos

Gelfand

et al. 2020

Surgical Neurology International

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Background: Acquired lumbar spondylolisthesis is often treated with interbody fusion. However, few studies have evaluated predictors for prolonged length of stay (LOS) and disposition to rehabilitation facilities after posterior single-level lumbar interbody fusion for acquired spondylolisthesis. Methods: The American College of Surgeons National Quality Improvement Program database was queried for adults with acquired spondylolisthesis who underwent single-level lumbar interbody fusion through a posterior approach (posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion [TLIF]). We utilized multivariate logistic regression analysis to identify predictors of prolonged LOS and disposition in this patient population. Results: Among 2080 patients identified, 700 (33.7%) had a prolonged LOS (≥4 days), and 306 (14.7%) were discharged postoperatively to rehabilitation facilities. Predictors for prolonged LOS included: American Society of Anesthesiologist (ASA) class ≥3, anemia, prolonged operative time, perioperative blood transfusion, pneumonia, urinary tract infections, and return to the operating room. The following risk factors predicted discharge to postoperative rehabilitation facilities: age ≥65 years, male sex, ASA class ≥3, modified frailty score ≥2, perioperative blood transfusion, and prolonged LOS. Conclusion: Multiple partial-overlapping risk factors predicted prolonged LOS and discharge to rehabilitation facilities after single-level TLIF/PLIF performed for acquired spondylolisthesis.

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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

Cited by 159 publications

References 27 publications

Spinal Surgery in Patients Aged 80 Years and Older: Risk Stratification Using the Modified Frailty Index

Spinal Surgery in Patients Aged 80 Years and Older: Risk Stratification Using the Modified Frailty Index

Are current DRG-based bundled payment models for lumbar fusions risk-adjusting adequately? An analysis of Medicare beneficiaries

Prolonged length of stay and discharge disposition to rehabilitation facilities following single-level posterior lumbar interbody fusion for acquired spondylolisthesis

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