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The 5-factor modified Frailty Index (mFI-5) predicts adverse outcomes after elective Anterior Lumbar Interbody Fusion
Neil P Patel1,2, Faisal Elali2, Daniel Coban1
1St. Joseph's University Medical Center, Department of Orthopaedic Surgery, 703 Main Street, Paterson, NJ 07503, USA.
Background:
The 5-factor modified frailty index (mFI-5) has been shown to be a concise and effective tool for predicting adverse events following various spine procedures. However, there have been no studies assessing its utility in patients undergoing anterior lumbar interbody fusion (ALIF). Therefore, the aim of this study was to analyze the predictive capabilities of the mFI-5 for 30-day postoperative adverse events following elective ALIF.
Methods:
The National Surgical Quality Improvement Program (NSQIP) database was queried from 2010 through 2019 to identify patients who underwent elective ALIF using Current Procedural Terminology (CPT) codes in patients over the age of 50. The mFI-5 score was calculated using variables for hypertension, congestive heart failure, comorbid diabetes, chronic obstructive pulmonary disease, and partially or fully dependent functional status which were each assigned 1 point. Univariate analysis and multivariate logistic regression models were utilized to identify the associations between mFI-5 scores, and 30-day rates of overall complications, readmissions, reoperations, and mortality.
Results:
11,711 patients were included (mFI-5=0: 4,026 patients, mFI-5=1: 5,392, mFI-5=2: 2,102, mFI-5=3+: 187. Multivariate logistic regression revealed that mFI-5 scores of 1 (OR: 2.2, CI: 1.2-4.2, p=0.02), 2 (OR: 3.6, CI: 1.8-7.3, p<0.001), and 3+ (OR: 7.0, CI: 2.5-19.3, p<0.001) versus a score of 0 were significant predictors of pneumonia. An mFI-5 score of 2 (OR: 1.3; CI: 1.01-1.6, p=0.04), and 3+ (OR: 1.9; CI: 1.1-3.1; p=0.01) were both independent predictors of related readmissions. An mFI score of 3+ was an independent predictor of any complication (OR: 1.5, CI: 1.01-2.2, p=0.004), UTI (OR: 2.4, CI: 1.1-5.2, p=0.02), and unplanned intubation (OR: 4.5, CI: 1.3-16.1, p=0.02).
Conclusions:
The mFI-5 is an independent predictor for 30-day postoperative complications, readmissions, UTI, pneumonia, and unplanned intubations following elective ALIF surgery in adults over the age of 50.
Insights
The 5-factor modified frailty index (mFI-5) predicts adverse events after anterior lumbar interbody fusion (ALIF) surgery. Higher mFI-5 scores correlate with increased risks of complications, pneumonia, and readmissions in patients over 50.
Area of Science:
- Spine Surgery
- Geriatric Surgery
- Surgical Outcomes Research
Background:
- The 5-factor modified frailty index (mFI-5) is a validated predictor of adverse events in spine surgery.
- Its utility in anterior lumbar interbody fusion (ALIF) remains unassessed.
Purpose of the Study:
- To evaluate the predictive capability of the mFI-5 for 30-day postoperative adverse events in patients undergoing elective ALIF.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program (NSQIP) database (2010-2019).
- Inclusion of patients over 50 undergoing elective ALIF.
- Calculation of mFI-5 scores based on hypertension, heart failure, diabetes, COPD, and functional status.
- Multivariate logistic regression to assess associations between mFI-5 and adverse events.
Main Results:
- Elevated mFI-5 scores (1, 2, 3+) significantly predicted pneumonia.
- Scores of 2 and 3+ predicted readmissions.
- A score of 3+ independently predicted overall complications, urinary tract infections (UTI), and unplanned intubations.
Conclusions:
- The mFI-5 is an independent predictor of 30-day postoperative complications, readmissions, UTI, pneumonia, and unplanned intubations after elective ALIF in adults over 50.
