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5-year outcomes of surgical intervention in patients with adult spine deformity according to preoperative 5-item modified frailty index scores

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Abstract

Purpose

Frailty increases vulnerability to dependency and/or death, and is important in predicting the risk for adverse effects following adult spinal deformity (ASD) surgery. For easy determination of frailty, the 5-item modified frailty index (mFI-5) was established. However, there are few reports that show the relationship between frailty and mid-term operative outcomes after ASD surgery. The objective of this retrospective study is to determine the correlation of frailty using mFi-5 scores with postoperative medical complications, patient reported outcome measures (PROMs), and radiographic alignment 5 years after ASD surgery.

Methods

208 patients were divided into robust (R), pre-frail (PF), and frail (F) groups based on mFI-5 scores. Postoperative medical complications, preoperative and 5-year follow-up PROMs and radiographic alignment were evaluated.

Results

The study included 91, 79, and 38 patients in group R, PF, and F, respectively. There was no significant difference in age and sex. Discharge to care facility (16 (18%):21 (27%):16 (42%), p = 0.014) and postoperative cardiac complications (2 (2%):0 (0%):3 (8%), p = 0.031) were higher in frail patients. Preoperative ODI (38.3:45.3:54.7, p < 0.001) and SRS-22 (2.7:2.5:2.3, p = 0.004), 5-year postoperative ODI (27:27.2:37.9, p = 0.015), 5-year postoperative SVA (57.8°:78.5°:86.4°, p = 0.039) and 5-year postoperative TPA (23.9°:29.4°:29.5°, p = 0.011) were significantly worse in group F compared to group R.

Conclusion

Postoperatively, frail patients are more likely to have cardiac complications, inferior PROMs and deterioration of post-correction global spinal alignment. Preoperative assessment using mFI-5 is beneficial to individualize risks, optimize patients, and manage postoperative expectations.

Level of evidence

3.

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Data availability

Raw data supporting Tables 1, 2, 3, 4, 5 and Figures 2, 3, 4 are not publicly available in order to protect patient privacy.

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Acknowledgements

None.

Funding

Medtronic Sofamor Danek Inc., Japan Medical Dynamic Marketing Inc., Meitoku Medical Institution and Jyuzen Memorial Hospital. We have not received funding from the NIH or HHMI.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Rina Therese R. Madelar, Shin Oe, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Koichiro Ide, Tomohiro Yamada, Kenta Kurosu, Keiichi Nakai & Yukihiro Matsuyama

  2. Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Shin Oe & Yu Yamato

  3. Department of Orthopedics, The Medical City, Ortigas Avenue, Pasig City, Philippines

    Rina Therese R. Madelar

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  1. Rina Therese R. Madelar
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Contributions

Rina Therese R. Madelar, MD-MBA: Acquisition, analysis, interpretation of data; Drafted and revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Shin Oe, MD, PhD: Acquisition, analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Yu Yamato, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Tomohiko Hasegawa, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Go Yoshida, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Tomohiro Banno, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Hideyuki Arima, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Koichiro Ide, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Tomohiro Yamada, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Kenta Kurosu, MD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Keiichi Nakai, MD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated. Yukihiro Matsuyama, MD, PhD: Analysis, interpretation of data; Revised manuscript; Approved version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated.

Corresponding author

Correspondence to Rina Therese R. Madelar.

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Conflict of interest

Dr. Shin Oe and Dr. Yu Yamato are members of the division of Geriatric Musculoskeletal Health funded by donors.

Ethical approval

The study protocol was approved by the Institutional Review Board of the Hamamatsu University School of Medicine, Shizuoka, Japan (IRB number 22-126).

Informed consent

Informed consent was obtained from participants of the study.

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Madelar, R.T.R., Oe, S., Yamato, Y. et al. 5-year outcomes of surgical intervention in patients with adult spine deformity according to preoperative 5-item modified frailty index scores. Spine Deform 12, 763–774 (2024). https://doi.org/10.1007/s43390-024-00823-0

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  • DOI: https://doi.org/10.1007/s43390-024-00823-0

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