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The 5-item modified frailty index predicts spinal osteotomy outcomes better than age in adult spinal deformity patients: an ACS − NSQIP analysis

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Abstract

Purpose

To evaluate the utility of 5-Item Modified Frailty Index (mFI-5) as compared to chronological age in predicting outcomes of spinal osteotomy in Adult Spinal Deformity (ASD) patients.

Methods

Using Current Procedural and Terminology (CPT) codes, the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) database was queried for adult patients undergoing spinal osteotomy from 2015 to 2019. Multivariate regression analysis was performed to evaluate the effect of baseline frailty status, measured by mFI-5 score, and chronological age on postoperative outcomes. Receiver-operating characteristic (ROC) curve analysis was performed to analyze the discriminative performance of age versus mFI-5.

Results

A total of 1,789 spinal osteotomy patients (median age 62 years) were included in the analysis. Among the patients assessed, 38.5% (n = 689) were pre-frail, 14.6% frail (n = 262), and 2.2% (n = 39) severely frail using the mFI-5. Based on the multivariate analysis, increasing frailty tier was associated with worsening outcomes, and higher odds ratios (OR) for poor outcomes were found for increasing frailty tiers as compared to age. Severe frailty was associated with the worst outcomes, e.g., unplanned readmission (OR 9.618, [95% CI 4.054–22.818], p < 0.001) and major complications (OR 5.172, [95% CI 2.271–11.783], p < 0.001). In the ROC curve analysis, mFI-5 score (AUC 0.838) demonstrated superior discriminative performance than age (AUC 0.601) for mortality.

Conclusions

The mFI5 frailty score was found to be a better predictor than age of worse postoperative outcomes in ASD patients. Incorporating frailty in preoperative risk stratification is recommended in ASD surgery.

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Data availability

All relevant data are included in the manuscript draft, tables, and figures. The raw data are available upon reasonable request from the corresponding author.

Code availability

Not applicable.

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Funding

The authors did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. School of Medicine, New York Medical College, Valhalla, NY, 10595, USA

    Omar H. Tarawneh, John Vellek, Rachel Thommen, Katie Roster & Matthew Conlon

  2. Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA

    Syed Faraz Kazim, Meic H. Schmidt & Christian A. Bowers

  3. School of Medicine, University of Panama, Simon Bolivar Avenue, Panama, Panama, 07096, USA

    Daniel J. Alvarez-Crespo

  4. School of Medicine, University of Utah, Salt Lake City, UT, USA

    Kyril L. Cole

  5. School of Medicine, University of New Mexico, Albuquerque, NM, 87131, USA

    Samantha Varela

  6. Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA

    Jose F. Dominguez

  7. Department of Surgery, University of New Mexico, Albuquerque, NM, USA

    Rohini G. Mckee

  8. Department of Neurosurgery MSC10 5615, Albuquerque, NM, 81731, USA

    Christian A. Bowers

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  1. Omar H. Tarawneh
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Contributions

Contributed to conception/design of work: OHT, JV, SFK, RT, KR, MC, DA-C, KLC, SV, JFD, RGM, MHS, CAB. Analysis/interpretation of data: OHT, JV, SFK, RT, KR, MC, DA-C, KLC, SV, MHS, CAB. Drafted the work: OHT, JV, SFK, RT, KR, MC, DA-C, KLC, SV, CAB. Critically revised the work: SFK, JFD, RGM, MHS, CAB. Oversaw the project: CAB, MHS. Approved version to be published: OHT, JV, SFK, RT, KR, MC, DA-C, KLC, SV, JFD, RGM, MHS, CAB. Agrees to be accountable for all aspects of the work: OHT, JV, SFK, RT, KR, MC, DA-C, KLC, SV, JFD, RGM, MHS, CAB.

Corresponding author

Correspondence to Christian A. Bowers.

Ethics declarations

Conflict of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Ethical approval

The present study was performed under the data user agreement (DUA) of the ACS with the University of New Mexico (UNM) and was approved by the Institutional Review Board of UNM School of Medicine (Study ID 21-315).

Consent to participate

Given the deidentified nature of the information in NSQIP database, patient consent was neither sought nor required.

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Tarawneh, O.H., Vellek, J., Kazim, S.F. et al. The 5-item modified frailty index predicts spinal osteotomy outcomes better than age in adult spinal deformity patients: an ACS − NSQIP analysis. Spine Deform 11, 1189–1197 (2023). https://doi.org/10.1007/s43390-023-00712-y

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  • DOI: https://doi.org/10.1007/s43390-023-00712-y

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