Frailty Syndrome and the Use of Frailty Indices as a Preoperative Risk Stratification Tool in Spine Surgery: A Review

Abstract

This comprehensive narrative literature review aims to extract studies related to frailty indices and their use in elective spine procedures, as limited studies regarding frailty exist in the spine literature. Most studies are retrospective analyses of prospectively collected databases. Evidence suggests a positive correlation between frailty level and mortality rate, postoperative complication rate, length of stay, and the possibility of discharge to a skilled nursing facility; these correlations have been illustrated across various spine procedures. The leading index is the modified frailty index, which measures 11 deficits. The development of more comprehensive frailty indices, such as the Adult Spinal Deformity Frailty Index, are promising and have high predictive value regarding postoperative complication rate in patients with spinal deformity. However, a frailty index that combines clinical, radiographic, and laboratory measures awaits development. Perhaps, the use of a frailty index in preoperative risk stratification for elective spine procedures could serve multiple purposes, including screening for high-risk patients, enhancement of operative decision making, approximation of complication rate for informed decision making, and refinement of perioperative care. Further prospective studies are warranted to determine clinically meaningful interventions in frail individuals.

fragilidad como índice predictor en cirugía de columna

“…Los estudios que abordan los índices de fragilidad en cirugías de columna son análisis retrospectivos de bases de datos recolectadas prospectivamente (1,5,(26)(27)(28)(29)(30) , de manera similar a lo que se realizó en esta serie. Los principales índices utilizados son el de fragilidad modificado (IFm) (1,18,27) , el de comorbilidad de Charlson (CCI) (34) , los Índices de deformidad espinal del adulto (Adult Spinal Deformity, ASD-FI) (26) y de deformidad cervical (Cervical Deformity, CD-FI) (4,30) .…”

“…Esta situación ha impulsado a que profesionales de diferentes especialidades quirúrgicas y ortopédicas se empeñen en diseñar sistemas de estratificación de riesgos que puedan predecir la probabilidad de complicaciones y mortalidad luego de determinados procedimientos. Históricamente, se han utilizado con este fin el score de la Sociedad Americana de Anestesiólogos (American Society of Anesthesiologists, ASA) (3)(4)(5)(6) y la edad de los pacientes (7) . Sin embargo, en cirugías de columna, el score de ASA ha obtenido resultados contradictorios como herramienta predictora (8)(9) y se ha reportado que la edad no guarda una relación lineal con las complicaciones (7)(8)(9)(10) , ya que la salud tiende a deteriorarse a diferentes velocidades en cada persona, con la consecuente discrepancia entre la edad fisiológica y la cronológica.…”

“…IFm posee un valor predictivo similar al score original (21) y ha sido validado en diferentes estudios (1,(22)(23)(24)(25) . Una mayor fragilidad medida por medio del IFm se asoció a tasas mayores de complicaciones postoperatorias, mortalidad y estadías hospitalarias más largas luego de cirugías de columna en diferentes subgrupos poblacionales (1,(4)(5)(26)(27)(28)(29)(30)(31) .…”

Utility of Frailty Screening Tools in Older Surgical Patients

“…While the modified frailty index was recommended, the researchers suggested the use of more comprehensive frailty indices specific for spinal surgery, such as the Adult Spinal Deformity frailty index, and consideration of adding clinical, radiographic, and laboratory measures to improve outcome predictions. 40) Another study that recalibrated and validated the Risk Analysis Index using a national surgical registry reported that the revision improved its discriminatory ability to predict mortality. 41) Based on currently available studies on older surgical patients, frailty screening appears to discriminate and identify high-risk patients regardless of screening tool and type of surgery.…”

Influence of Frailty on Life Expectancy in Octogenarians After Lumbar Spine Surgery

“…Using the simplified frailty measurement index, the modified Frailty Index (mFI), many studies confirmed that frail patients had higher complication and mortality rate in spinal surgery [10][11][12][13][14] .…”