Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Length of Stay After Spine Surgery

Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

“…Frailty indexes: Frailty was evaluated with the previously described mFI [33] and the MSFTI [18]. The MFI consists of 11 variables including comorbidities and deficits.…”

“…Frailty denotes a state of weakened reserve against stressors and may occur independent of and out of proportion to chronological age [15,16]. One conceptual model of frailty is the theory of the accumulation of deficits which led to the development of frailty indices including the Modified Frailty Index (mFI) [17] and the Metastatic Spinal Tumor Frailty Index (MSTFI) [18]. Derived from large databases, these indexes have been shown to predict adverse events and mortality following spine surgery [18−21].…”

“…In prior studies, sarcopenia has been evaluated in a practical fashion by measuring the total area of the psoas muscle on axial computed tomography (CT) scanning although consensus on the appropriate threshold is lacking. Frailty has been shown to predict adverse outcomes in multiple spinal surgical populations [18,19,21,31,32]. In the metastatic spine disease population, frailty and sarcopenia may be potentially useful tools to guide surgical candidacy, urgency and planning, yet, their usefulness to predict mortality and AEs remains unknown in this challenging population.…”

Prevalence of spinal metastases: a descriptive cross-sectional update and literature review / Prevalência em metástases espinais: atualização de estudo transversal descritiva e revisão da literatura

“…Neurologically asymptomatic patients without acute nervous tissue compression and segmental vertebral instability are initially managed with nonsurgical treatment (8,(16)(17)(18)(19)(20)(21)(22)(23)(24) . As for symptomatic spinal metastasis, these patients are inserted into the advanced cancer stage, have limited estimated life expectancy, and few patients are submitted to surgical treatment relative to the frequent finding in cancer patients harboring skeleton located metastases (8,10,(16)(17)(18)(19)(20)(21)(22)(23)(24) . Furthermore, inductive reasoning derived from multiple observations that approximately 10% of symptomatic patients that harbor spinal metastases are managed with palliative surgery (7)(8)(9) and 128 patients in this descriptive study were managed with palliative surgery, one can infer in this census that 1,152 (90%) symptomatic patients received non-surgical management in a cohort of 1,280 (100%) in this 21-years time's series.…”

“…Cancers are considered advanced when they cannot be cured or controlled with treatment and are generally managed by non-surgical measures (1,(5)(6) . As for those patients that harbor symptomatic spinal epidural metastasis, approximately 10% are managed with palliative surgery, which indicates that only a minority of patients with spinal epidural metastases in the advanced cancer stage is operated (7)(8)(9)10) .…”