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Frailty Stratification Using the Modified 5-Item Frailty Index: Significant Variation within Frailty Patients in
Gaston Camino-Willhuber1, Henryk Haffer2, Maximilian Muellner2
1Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA.
Background:
Frailty status has been associated with higher rates of complications after spine surgery. However, frailty patients constitute a heterogeneous group based on the combinations of comorbidities. The objective of this study is to compare the combinations of variables that compose the modified 5-factor frailty index score (mFI-5) based on the number of comorbidities in terms of complications, reoperation, readmission, and mortality after spine surgery.
Methods:
The American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Database from 2009-2019 was used to identify patients who underwent elective spine surgery. The mFI-5 item score was calculated and patients were classified according to number and combination of comorbidities. Multivariable analysis was used to assess the independent impact of each combination of comorbidities in the mFI-5 score on the risk of complications.
Results:
A total of 167, 630 patients were included with a mean age of 59.9 ± 13.6 years. The risk of complications was the lowest in patients with diabetes + hypertension (OR = 1.2) and highest in those with the combination of congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disease (COPD), and dependent status (OR = 6.6); there was a high variation in complication rate based on specific combinations.
Conclusions:
There is high variability in terms of relative risk of complications based on the number and combination of different comorbidities, especially with CHF and dependent status. Therefore, frailty status encompasses a heterogeneous group and sub-stratification of frailty status is necessary to identify patients with significantly higher risk of complications.
Insights
Frailty in spine surgery patients is complex. Specific comorbidity combinations, especially with heart failure and dependency, significantly increase complication risks, necessitating tailored risk assessments.
Area of Science:
- Spine Surgery Outcomes
- Geriatric Surgery
- Surgical Comorbidity Assessment
Background:
- Frailty is linked to increased complications post-spine surgery.
- Frailty assessment is complicated by heterogeneous comorbidity profiles.
- The modified 5-factor frailty index (mFI-5) is used to quantify frailty.
Purpose of the Study:
- To compare combinations of variables composing the mFI-5 score.
- To evaluate the impact of comorbidity combinations on outcomes after spine surgery.
- To identify specific frailty profiles associated with higher risks.
Main Methods:
- Utilized the ACS-NSQIP Database (2009-2019) for elective spine surgery patients.
- Calculated mFI-5 scores and classified patients by comorbidity number and combination.
- Employed multivariable analysis to assess the independent impact of mFI-5 comorbidity combinations on complication risk.
Main Results:
- Included 167,630 patients (mean age 59.9 years).
- Lowest complication risk observed with diabetes + hypertension (OR=1.2).
- Highest complication risk seen with congestive heart failure, diabetes, COPD, and dependent status (OR=6.6).
- Significant variation in complication rates across different comorbidity combinations.
Conclusions:
- Comorbidity combinations within frailty status show high variability in complication risk.
- Congestive heart failure and dependent status are key factors in elevated risk.
- Sub-stratification of frailty is crucial for identifying high-risk spine surgery patients.
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