The 5-factor modified frailty index (mFI-5) is predictive of 30-day postoperative complications and readmission in patients with adult spinal deformity (ASD)


      • 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.



      There is limited research regarding the association between the mFI-5 and postoperative complications among adult spinal deformity (ASD) patients.


      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.


      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.


      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.


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        • Leven D.M.
        • Lee N.J.
        • Kim J.S.
        • Kothari P.
        • Steinberger J.
        • Guzman J.
        • et al.
        Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion.
        Glob Spine J. 2017; 7: 529-535
        • Subramaniam S.
        • Aalberg J.J.
        • Soriano R.P.
        • Divino C.M.
        New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data.
        J Am Coll Surg. 2018; 226: 173-181.e8
      1. 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.

        • Wahl T.S.
        • Graham L.A.
        • Hawn M.T.
        • Richman J.
        • Hollis R.H.
        • Jones C.E.
        • et al.
        Association of the Modified Frailty Index With 30-Day Surgical Readmission.
        JAMA Surg. 2017; 152: 749-757
        • Weaver D.J.
        • Malik A.T.
        • Jain N.
        • Yu E.
        • Kim J.
        • Khan S.N.
        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-e632
        • Wilson J.M.
        • Holzgrefe R.E.
        • Staley C.A.
        • Schenker M.L.
        • Meals C.G.
        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: 701-709
      2. 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.

        • Chen X.
        • Mao G.
        • Leng S.X.
        Frailty syndrome: an overview.
        Clin Interv Aging. 2014; 9: 433-441
        • Rockwood K.
        • Song X.
        • MacKnight C.
        • Bergman H.
        • Hogan D.B.
        • McDowell I.
        • et al.
        A global clinical measure of fitness and frailty in elderly people.
        CMAJ. 2005;
        • Hubbard R.E.
        • Peel N.M.
        • Samanta M.
        • Gray L.C.
        • Fries B.E.
        • Mitnitski A.
        • et al.
        Derivation of a frailty index from the interRAI acute care instrument.
        BMC Geriatr. 2015;
        • Tsiouris A.
        • Hammoud Z.T.
        • Velanovich V.
        • Hodari A.
        • Borgi J.
        • Rubinfeld I.
        A modified frailty index to assess morbidity and mortality after lobectomy.
        J Surg Res. 2013;
        • Leven D.M.
        • Lee N.J.
        • Kothari P.
        • Steinberger J.
        • Guzman J.
        • Skovrlj B.
        • et al.
        Frailty Index Is a Significant Predictor of Complications and Mortality After Surgery for Adult Spinal Deformity.
        Spine (Phila Pa 1976). 2016; : 2016;41
        • Ali R.
        • Schwalb J.M.
        • Nerenz D.R.
        • Antoine H.J.
        • Rubinfeld I.
        Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery.
        J Neurosurg Spine SPI. 2016; 25: 537-541
        • Phan K.
        • Kim J.S.
        • Lee N.J.
        • Somani S.
        • Di Capua J.
        • Kothari P.
        • et al.
        Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery.
        Spine J. 2017; 17: 538-544
        • Holzgrefe R.E.
        • Wilson J.M.
        • Staley C.A.
        • Anderson T.L.
        • Wagner E.R.
        • Gottschalk M.B.
        Modified frailty index is an effective risk-stratification tool for patients undergoing total shoulder arthroplasty.
        J Shoulder Elb Surg. 2019; 28: 1232-1240
        • Evans D.R.
        • Saltzman E.B.
        • Anastasio A.T.
        • Guisse N.F.
        • Belay E.S.
        • Pidgeon T.S.
        • et al.
        Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures.
        JSES Int. 2021; 5: 212-219
        • Saltzman E.B.
        • Evans D.R.
        • Anastasio A.
        • Guisse N.
        • Belay E.S.
        • Anakwenze O.A.
        • et al.
        Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of distal humerus fractures.
        JSES Int. 2021; 5: 1111-1118
        • Segal D.N.
        • Wilson J.M.
        • Staley C.
        • Michael K.W.
        The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation.
        World Neurosurg. 2018; 116: e225-e231
        • Lee N.J.
        • Kothari P.
        • Kim J.S.
        • Shin J.I.
        • Phan K.
        • Di Capua J.
        • et al.
        Early Complications and Outcomes in Adult Spinal Deformity Surgery: An NSQIP Study Based on 5803 Patients.
        Glob Spine J. 2017; 7: 432-440
        • Bhagat S.
        • Vozar V.
        • Lutchman L.
        • Crawford R.J.
        • Rai A.S.
        Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience.
        Eur Spine J. 2013; 22: S42-S46
        • Glassman S.D.
        • Hamill C.L.
        • Bridwell K.H.
        • Schwab F.J.
        • Dimar J.R.
        • Lowe T.G.
        The Impact of Perioperative Complications on Clinical Outcome in Adult Deformity Surgery.
        Spine (Phila Pa 1976). 2007; : 2007;32
        • Scheer J.K.
        • Smith J.S.
        • Schwab F.
        • Lafage V.
        • Shaffrey C.I.
        • Bess S.
        • et al.
        Development of a preoperative predictive model for major complications following adult spinal deformity surgery.
        J Neurosurg Spine SPI. 2017; 26: 736-743
        • Passias P.G.
        • Jalai C.M.
        • Line B.G.
        • Poorman G.W.
        • Scheer J.K.
        • Smith J.S.
        • et al.
        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;
        • Diebo B.G.
        • Shah N.V.
        • Boachie-Adjei O.
        • Zhu F.
        • Rothenfluh D.A.
        • Paulino C.B.
        • et al.
        Adult spinal deformity.
        Lancet. 2019;
        • Moskven E.
        • Bourassa-Moreau É.
        • Charest-Morin R.
        • Flexman A.
        • Street J.
        The impact of frailty and sarcopenia on postoperative outcomes in adult spine surgery. A systematic review of the literature.
        Spine J. 2018; 18: 2354-2369
        • Flexman A.M.
        • Charest-Morin R.
        • Stobart L.
        • Street J.
        • Ryerson C.J.
        Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease.
        Spine J. 2016; 16: 1315-1323
        • Pierce K.E.
        • Naessig S.
        • Kummer N.
        • Larsen K.
        • Ahmad W.
        • Passfall L.
        • et al.
        The Five-item Modified Frailty Index is Predictive of 30-day Postoperative Complications in Patients Undergoing Spine Surgery.
        Spine (Phila Pa 1976). 2021; : 939-943