Highlights
- •Little literature assesses mFI-5 as a predictor for outcomes in ASD patients.
- •An mFI-5 score of 1 or 2 was associated with 30-day reoperations.
- •An mFI-5 score of 1 or 2 was associated with 30-day related and any readmissions.
- •This supports mFI-5 as a possible predictor for adverse postoperative outcomes.
Abstract
Background
There is limited research regarding the association between the mFI-5 and postoperative
complications among adult spinal deformity (ASD) patients.
Methods
Using the National Surgical Quality Improvement Project (NSQIP) database, patients
with Current Procedural Terminology (CPT) codes for > 7-level fusion or < 7-level
fusion with International Classification of Diseases, Ninth Revision (ICD-9) codes
for ASD were identified between 2008 and 2016. Univariate analyses with post-hoc Bonferroni
correction for demographics and preoperative factors were performed. Logistic regression
assessed associations between mFI-5 scores and 30-day post-operative outcomes.
Results
2,120 patients met criteria. Patients with an mFI-5 score of 4 or 5 were excluded,
given there were<20 patients with those scores. Patients with mFI-5 scores of 1 and
2 had increased 30-day rates of pneumonia (3.5 % and 4.3 % vs 1.6 %), unplanned postoperative
ventilation for > 48 h (3.1 % and 4.3 % vs 0.9 %), and UTIs (4.4 % and 7.4 % vs 2.0 %)
than patients with a score of 0 (all, p < 0.05). Logistic regression revealed that
compared to an mFI-5 of 0, a score of 1 was an independent predictor of 30-day reoperations
(OR = 1.4; 95 % CI 1.1–18). A score of 2 was an independent predictor of overall (OR = 2.4;
95 % CI 1.4–4.1) and related (OR = 2.2; 95 % CI 1.2–4.1) 30-day readmissions. A score
of 3 was not predictive of any adverse outcome.
Conclusion
The mFI-5 score predicted complications and postoperative events in the ASD population.
The mFI-5 may effectively predict 30-day readmissions. Further research is needed
to identify the benefits and predictive value of mFI-5 as a risk assessment tool.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion.Glob Spine J. 2017; 7: 529-535https://doi.org/10.1177/2192568217700099
- New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data.J Am Coll Surg. 2018; 226: 173-181.e8https://doi.org/10.1016/j.jamcollsurg.2017.11.005
Traven S, Reeves R, G Sekar M, Slone H, Walton Z. New 5-Factor Modified Frailty Index Predicts Morbidity and Mortality in Primary Hip and Knee Arthroplasty. vol. 34. 2018. https://doi.org/10.1016/j.arth.2018.09.040.
- Association of the Modified Frailty Index With 30-Day Surgical Readmission.JAMA Surg. 2017; 152: 749-757https://doi.org/10.1001/jamasurg.2017.1025
- 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.World Neurosurg. 2019; 124: e626-e632https://doi.org/10.1016/j.wneu.2018.12.168
- Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures.J Hand Surg Am. 2018; 43: 701-709https://doi.org/10.1016/j.jhsa.2018.05.029
Yagi M, Michikawa T, Hosogane N, Fujita N, Okada E, Suzuki S, et al. The 5-Item modified frailty index is predictive of severe adverse events in patients undergoing surgery for adult spinal deformity. Spine (Phila Pa 1976) 9000;Publish Ah.
- Frailty syndrome: an overview.Clin Interv Aging. 2014; 9: 433-441https://doi.org/10.2147/CIA.S45300
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; https://doi.org/10.1503/cmaj.050051
- Derivation of a frailty index from the interRAI acute care instrument.BMC Geriatr. 2015; https://doi.org/10.1186/s12877-015-0026-z
- A modified frailty index to assess morbidity and mortality after lobectomy.J Surg Res. 2013; https://doi.org/10.1016/j.jss.2012.11.059
- Frailty Index Is a Significant Predictor of Complications and Mortality After Surgery for Adult Spinal Deformity.Spine (Phila Pa 1976). 2016; : 2016;41
- Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery.J Neurosurg Spine SPI. 2016; 25: 537-541https://doi.org/10.3171/2015.10.SPINE14582
- Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery.Spine J. 2017; 17: 538-544https://doi.org/10.1016/j.spinee.2016.10.023
- Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty.J Shoulder Elb Surg. 2019; 28: 1232-1240https://doi.org/10.1016/j.jse.2018.12.004
- Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures.JSES Int. 2021; 5: 212-219https://doi.org/10.1016/j.jseint.2020.10.017
- Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of distal humerus fractures.JSES Int. 2021; 5: 1111-1118https://doi.org/10.1016/j.jseint.2021.07.016
- The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation.World Neurosurg. 2018; 116: e225-e231https://doi.org/10.1016/j.wneu.2018.04.172
- Early Complications and Outcomes in Adult Spinal Deformity Surgery: An NSQIP Study Based on 5803 Patients.Glob Spine J. 2017; 7: 432-440https://doi.org/10.1177/2192568217699384
- Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience.Eur Spine J. 2013; 22: S42-S46https://doi.org/10.1007/s00586-012-2627-y
- The Impact of Perioperative Complications on Clinical Outcome in Adult Deformity Surgery.Spine (Phila Pa 1976). 2007; : 2007;32
- Development of a preoperative predictive model for major complications following adult spinal deformity surgery.J Neurosurg Spine SPI. 2017; 26: 736-743https://doi.org/10.3171/2016.10.SPINE16197
- Patient profiling can identify patients with adult spinal deformity (ASD) at risk for conversion from nonoperative to surgical treatment: initial steps to reduce ineffective ASD management.Spine J. 2018; https://doi.org/10.1016/j.spinee.2017.06.044
- Adult spinal deformity.Lancet. 2019; https://doi.org/10.1016/S0140-6736(19)31125-0
- The impact of frailty and sarcopenia on postoperative outcomes in adult spine surgery. A systematic review of the literature.Spine J. 2018; 18: 2354-2369https://doi.org/10.1016/j.spinee.2018.07.008
- Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease.Spine J. 2016; 16: 1315-1323https://doi.org/10.1016/j.spinee.2016.06.017
- The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery.Spine (Phila Pa 1976). 2021; : 939-943https://doi.org/10.1097/BRS.0000000000003936
Article info
Publication history
Accepted:
July 24,
2022
Received:
April 28,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
