The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

Abstract

Frailty is a condition characterized by a high vulnerability to low-power stressor. Frailty increases with age and is associated with higher complications and mortality. Several indexes have been used to quantify frailty. Spine diseases, both degenerative and oncologic, frequently require surgery which is related to complications and mortality. Aim of the present systematic review was to collect the most frequently used frailty indexes in clinics to predict surgical outcomes in patients affected by spine diseases, taking into account gender differences. Three databases were employed, and 29 retrospective clinical studies were included in this systematic review. The identified spine pathologies were primary and metastatic spine tumors, adult spine deformity (ASD), degenerative spine disease (DSD), cervical deformity (CD) and other pathologies that affected lumbar spine or multiple spine levels. Eleven indexes were identified: modified Frailty Index (mFI), Adult spinal deformity frailty index (ASD-FI), mFI-5, Metastatic Spinal Tumor Frailty Index (MSTFI), Fried criteria, Cervical deformity frailty index (CD-FI), Spinal tumor frailty index (STFI), Frailty Phenotype criteria (FP), Frailty Index (FI), FRAIL scale and Modified CD-FI (mCD-FI). All these indexes correlated well with minor and major postoperative complications, mortality and length of stay in hospital. Results on gender differences and frailty are still conflicting, although few studies show that women are more likely to develop frailty and more complications in the post-operative period than men. This systematic review could help the surgeon in the adoption of frailty indexes, before the operation, and in preventing complications in frail patients.

Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data

“…The prevalence of frailty increases with age, and it is more frequent in females than in males. Numerous indices are currently in use for the assessment of frailty based on a variety of settings and diseases, related to the “Frailty Phenotype” or the “Deficit Accumulation Index or Frailty Index” models [ 8 ]. On one hand, clinical trials have demonstrated that the presence of OA is significantly associated with a higher risk of being frail [ 9 , 10 , 11 , 12 , 13 , 14 ]; on the other hand, the role of frailty in the development of degenerative joint diseases has been hypothesized due to the increase in pro-inflammatory mediators and the presence of sarcopenia associated with a higher fall risk [ 15 ].…”

The performance of frailty in predictive modeling of short-term outcomes in the surgical management of metastatic tumors to the spine

“…In addition, a previous systematic review by Veronesi et al found that there may be an issue regarding the relationship between the frailty level and gender, with worsening of frailty being prevalent in women, which represents an area of future research with regards to accuracy of frailty assessments. [51] The FI is not intended to replace current validated scoring systems specific to prognostication of spinal metastatic disease, [8,12,52] rather the addition of FI evaluation may improve their predictability performance. Ghori et al improved the predictability of survival from the modified Baur score [52] (AUC=0.64) by the addition of nutrition and ambulation (AUC=0.74), termed the New England Spinal Metastasis Score (NESMS).…”

Which frailty scales for patients with adult spinal deformity are feasible and adequate? A systematic review

“…The predictive value of frailty scales could be affected by various factors other than age as well. This review revealed the predictive values of frailty scales including mFI-11, the most frequently used scale in the spine population [13], were controversial depending on a variety of study settings (e.g. spinal disorders, surgical procedures, age and frailty at baseline, frailty scales, cut-off values, and outcomes of the study).…”

“…spinal disorders, surgical procedures, age and frailty at baseline, frailty scales, cut-off values, and outcomes of the study). Although Veronesi et al recently concluded that mFI can be applied at any age in all spinal disorders [13], this means, that as yet we have to pay careful attention in deciding which frailty scale to use depending on the outcomes and the setting of interest [115].…”

“…Whereas a variety of frailty scales have been well evaluated in non-spine populations [9], it still remains unclear which scales are appropriate in spine populations because previous reviews found only a few frailty scales used in spine studies [6,[10][11][12]. Recently, Veronesi et al performed a systematic review and identified eleven frailty scales out of 29 clinical spine studies [13]. They reported predictive value of frailty for surgical outcomes in several types of spinal disorders, but failed to assess the feasibility and measurement properties of frailty scales, though these evaluations are imperative to select an appropriate scale for the settings of interest.…”