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Updated: Jul 18, 2025
Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
The 5-Factor Modified Frailty Index is Associated With Increased Risk of Reoperations and Adjacent Level Disease
Neil Patel1, Daniel Coban1, Stuart Changoor1
1Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA.
Study Design:
Retrospective Cohort Study.
Objectives:
To determine the predictive capability between the 5-factor modified frailty index (mFI-5) scores and adverse clinical and radiographic outcomes following single-level transforaminal lumbar interbody fusion (TLIF).
Methods:
All patients over the age of 50 undergoing single-level open or minimally invasive TLIF from 2012 to 2021 with a minimum follow-up of 1 year were identified. Deformity, trauma, emergency, and tumor cases were excluded as were patients undergoing revision surgeries. An mFI-5 score was computed for each patient using a set of five factors which included hypertension requiring medication, chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, and partially or fully dependent functional status. Univariate and multivariate logistic regression analysis were performed to evaluate the impact of mFI-5 scores on readmissions, reoperations, and postoperative complications.
Results:
156 patients were included and grouped according to their level of frailty: no-frailty (mFI = 0, n = 67), mild frailty (mFI = 1, n = 59), and severe frailty (mFI = 2+, n = 30). Multivariate analysis found high levels of frailty (mFI = 2+) to be independent predictors of reoperation (OR: 16.9, CI: 2.7 - 106.9, P = .003) and related readmissions (OR = 16.5, CI: 2.6 - 102.7, P = .003) as compared to the no-frailty group. An mFI-5 score of 2+ was also predictive of any complication (OR = 4.5, CI: 1.4 - 14.3, P = .01) and adjacent segment disease (ASD) (OR = 12.5, CI: 1.2 - 134.0, P = .037).
Conclusion:
High levels of frailty were predictive of related readmissions, reoperations, any complications, and ASD in older adult patients undergoing single-level TLIF.
Insights
High frailty, measured by the modified frailty index (mFI-5), predicts reoperations, readmissions, and complications after lumbar fusion surgery in older adults. This highlights frailty as a key factor in surgical outcomes.
Area of Science:
- Spine surgery outcomes
- Geriatric surgery assessment
- Patient risk stratification
Background:
- Transforaminal lumbar interbody fusion (TLIF) is a common procedure for lumbar spine conditions.
- Assessing patient frailty is crucial for predicting surgical outcomes.
- The 5-factor modified frailty index (mFI-5) is a tool to quantify frailty.
Purpose of the Study:
- To evaluate the predictive accuracy of the mFI-5 for adverse outcomes after single-level TLIF.
- To identify frailty as a risk factor for complications and reoperations in this patient population.
Main Methods:
- Retrospective cohort study of patients over 50 undergoing single-level TLIF (2012-2021).
- Exclusion of deformity, trauma, tumor, and revision cases.
- Calculation of mFI-5 scores and analysis of outcomes including readmissions, reoperations, and complications using logistic regression.
Main Results:
- 156 patients were analyzed, categorized by frailty: no-frailty (mFI=0, n=67), mild frailty (mFI=1, n=59), and severe frailty (mFI=2+, n=30).
- Severe frailty (mFI=2+) independently predicted reoperation (OR=16.9) and related readmissions (OR=16.5) compared to no frailty.
- High frailty (mFI=2+) also predicted overall complications (OR=4.5) and adjacent segment disease (ASD) (OR=12.5).
Conclusions:
- Elevated frailty levels, as indicated by mFI-5 scores of 2+, are significant predictors of adverse outcomes in older adults undergoing TLIF.
- These outcomes include increased risk of reoperation, readmission, general complications, and adjacent segment disease.
- The mFI-5 is a valuable tool for risk assessment in patients undergoing single-level TLIF.
