High Modified 5 Factor Frailty Index is Associated With Worse PROMs and Decreased Return to Activities After 1 or 2...

Area of Science:

• Spine surgery outcomes
• Geriatric surgery assessment
• Patient-reported outcome measures

Background:

• Frailty, a state of reduced physiologic reserve, impacts surgical outcomes.
• The modified 5 factor frailty index (mFI-5) is a validated frailty metric.
• Limited data exists on mFI-5's predictive value for patient-reported outcomes (PROMs) after spine surgery.

Purpose of the Study:

• To evaluate the association between frailty, as assessed by the mFI-5, and postoperative outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
• To compare PROMs, return to activity, and fusion rates between frail and non-frail patients.

Main Methods:

• Retrospective cohort study of 392 patients undergoing 1- or 2-level MI-TLIF.
• Frailty assessed using the mFI-5, categorizing patients into non-frail, moderately frail, and severely frail groups.
• Comparison of operative time, blood loss, PROMs (ODI, VAS), SF-12 scores, fusion rates, and return to activity between frailty cohorts.

Main Results:

• Frail patients (n=165) experienced longer operative times (P=0.002) and greater blood loss (P=0.038) compared to non-frail patients (n=227).
• At long-term follow-up, frail patients reported worse ODI (P=0.009), VAS-back (P=0.028), VAS-leg (P=0.004), and SF-12 PCS scores (P<0.001).
• Frail patients had lower fusion rates at 1 year (P=0.002) and reduced rates of returning to work (P=0.018) and driving (P=0.027).

Conclusions:

• The mFI-5 effectively identifies frail patients who experience significantly worse postoperative outcomes after MI-TLIF.
• These findings underscore the importance of careful patient selection and preoperative optimization for frail individuals undergoing lumbar fusion.
• Frailty assessment should be integrated into the preoperative evaluation for MI-TLIF to mitigate adverse outcomes.