Frailty Index Is a Significant Predictor of Complications and Mortality After Surgery for Adult Spinal Deformity

Leven, Dante M.; Lee, Nathan J.; Kothari, Parth; Steinberger, Jeremy; Guzman, Javier Z.; Skovrlj, Branko; Shin, John I.; Caridi, John M.; Cho, Samuel K.

doi:10.1097/brs.0000000000001886

Cited by 180 publications

(146 citation statements)

References 24 publications

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“…Because it moves beyond age or any single organ‐system, it has been demonstrated that frailty is a stronger predictor of postoperative outcomes compared with several previous surgical risk‐assessment tools, and it is increasingly recognized as a valuable measure in nononcologic surgical patients . For example, the mFI has been validated in several studies as a reliable measure of postoperative complications, discharge destination, and mortality in vascular, orthopedic, gynecologic, thoracic, and general surgeries . Similarly, it has been demonstrated that phenotypic frailty is predictive of postoperative outcomes in patients presenting for elective surgery, including major abdominal and transplantation surgeries .…”

Section: Frailty and Oncology Surgerymentioning

confidence: 99%

Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology

Ethun

Bilen

Jani

et al. 2017

CA A Cancer J Clinicians

453

324

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https://www.wileyhealthlearning.com/acs.aspx The concept of frailty has become increasingly recognized as one of the most important issues in health care and health outcomes and is of particular importance in patients with cancer who are receiving treatment with surgery, chemotherapy, and radiotherapy. Because both cancer itself, as well as the therapies offered, can be significant additional stressors that challenge a patient's physiologic reserve, the incidence of frailty in older patients with cancer is especially high—it is estimated that over one‐half of older patients with cancer have frailty or prefrailty. Defining frailty can be challenging, however. Put simply, frailty is a state of extreme vulnerability to stressors that leads to adverse health outcomes. In reality, frailty is a complex, multidimensional, and cyclical state of diminished physiologic reserve that results in decreased resiliency and adaptive capacity and increased vulnerability to stressors. In addition, over 70 different measures of frailty have been proposed. Still, it has been demonstrated that frail patients are at increased risk of postoperative complications, chemotherapy intolerance, disease progression, and death. Although international standardization of frailty cutoff points are needed, continued efforts by oncology physicians and surgeons to identify frailty and promote multidisciplinary decision making will help to develop more individualized management strategies and optimize care for patients with cancer. CA Cancer J Clin 2017;67:362–377. © 2017 American Cancer Society.

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Section: Frailty and Oncology Surgerymentioning

confidence: 99%

Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology

Ethun

Bilen

Jani

et al. 2017

CA A Cancer J Clinicians

453

324

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“…1,2 More recently, the Canadian Study of Health and Aging Frailty Index (CSHA-FI) validated 70 variables as markers of frailty. 3 This has been further refined to form the Modified Frailty Index (mFI), which comprises 11 variables. An individual's mFI is denoted as n/11, wherein n is the number of the 11 variables satisfied.…”

Section: Introductionmentioning

confidence: 99%

Spinal Surgery in Patients Aged 80 Years and Older: Risk Stratification Using the Modified Frailty Index

Kweh

Lee

Tan

et al. 2020

Global Spine Journal

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Study Design: This was an ambispective clinical quality registry study. Objective: To evaluate utility of 11-variable modified Frailty Index (mFI) in predicting postoperative outcomes among patients ≥80 years undergoing spinal surgery. Methods: Consecutive patients ≥80 years who underwent spinal surgery between January 1, 2013, and June 30, 2018, were included. Primary outcome measure was rate of major complication. Secondary outcome measures were (1) overall complication rate, (2) surgical site infection, and (3) 6-month mortality. Results: A total of 121 operations were performed. Demographic metrics were (1) age (mean ± SD) = 83.1 ± 2.8 years and (2) mFI (mean ± SD) = 2.1 ± 1.4 variables. As mFI increased from 0 to ≥4 variables, risk of major complication increased from 18.2% to 40.0% ( P = .014); overall complication increased from 45.5% to 70.0% ( P = .032); surgical site infection increased from 0.0% to 25.0% ( P = .007). There were no significant changes in risk of 6-month mortality across mFIs ( P = .115). Multivariate analysis showed that a higher mFI score of ≥3 variables was associated with a significantly higher risk of (1) major complication ( P = .025); (2) overall complication ( P = .015); (3) surgical site infection ( P = .007); and (4) mortality ( P = .044). Conclusions: mFI scores of ≥3/11 variables were associated with a higher risk of postoperative morbidity in patients aged ≥80 years undergoing spinal surgery. The mFI-associated risk stratification provides a valuable adjunct in surgical decision making for this rapidly growing subpopulation of patients.

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“…With such a low proportion, missing data handling techniques are unlikely to affect it [16]. However, there are other aggregate scores of medical condition that can be calculated from NSQIP variables such as the Charlson Comorbidity Index, the Modified Frailty Index, and the Elixhauser Comorbidity Index and have been used in prior database studies [5,24,29]. At least one variable included in each of these is frequently missing in NSQIP.…”

Section: Discussionmentioning

confidence: 99%

Results of Database Studies in Spine Surgery Can Be Influenced by Missing Data

Basques

McLynn

Fice

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Until there are better guidelines on the best approaches to handle missing data, investigators should report how missing data were handled to increase the quality and transparency of orthopaedic database research. Readers of large database studies should note whether handling of missing data was addressed and consider potential bias with high rates or unspecified or weak methods for handling missing data.

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Frailty Index Is a Significant Predictor of Complications and Mortality After Surgery for Adult Spinal Deformity

Abstract: 3.

Cited by 180 publications

References 24 publications

Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology

Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology

Spinal Surgery in Patients Aged 80 Years and Older: Risk Stratification Using the Modified Frailty Index

Results of Database Studies in Spine Surgery Can Be Influenced by Missing Data

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