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Updated: Aug 11, 2026
Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique
Published on: July 15, 2021
Modifiable Uncontrolled Frailty (mFI-5) in Lumbar Fusion Outcomes
Jarod Olson1, Jonathan Dalton, Gregorio Baek
1Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107.
Study Design:
Retrospective Cohort.
Objective:
To investigate impact of controlled/uncontrolled sub-stratification of modified frailty index (MFI-5) on postoperative outcomes after lumbar fusion for degenerative disease.
Background:
mFI-5 outperforms age as a predictor of postoperative risk. Sub-stratification of mFI-5 by controlled versus uncontrolled frailty has allowed for better risk prognostication in spinal deformity cases.
Methods:
Adult patients who underwent elective, single-level lumbar fusion (2017-2021) were identified. Fusions for infection/trauma/tumor/revision were excluded. Patients were classified as frail/non-frail based on having any mFI-5 criteria (history of chronic obstructive pulmonary disease [COPD], congestive heart failure [CHF], diabetes mellitus [DM], hypertension [HTN] requiring medication, and functional status). Frailty was considered controlled unless patients had a COPD exacerbation within 3 months prior to surgery, preoperative hemoglobin A1c >7, or HTN ≥140/90 mmHg for ≥2 visits.
Results:
1,286 patients were included (controlled/uncontrolled/non-frail-804/159/323). Uncontrolled frailty patients had more 31-90 day ED visits (9.43% vs. 4.13%,P=0.009), 0-30 day readmissions (5.66% vs. 2.49%,P=0.042), and renal complications (13.2% vs. 6.38%,P=0.005) compared to controlled frailty patients. Controlled frailty patients were older (56.3 vs. 62.9, P<0.001) and had more 0-30 day ED visits (2.19% vs. 5.63%,P=0.021) compared to non-frail patients. Uncontrolled frailty patients were older (56.3 vs. 63.8,P<0.001), and had higher 0-30 (2.19% vs. 7.55%,P=0.010) and 31-90 day ED visits (1.88% vs. 9.43%,P<0.001), 0-30 day readmissions (0.93% vs. 5.66%,P=0.003), and renal complications (3.76% vs. 13.2%,P<0.001) compared to non-frail patients. Multivariable regression demonstrated that uncontrolled frailty alone was independently associated with 30-day ED visits (odds ratio [OR]-3.68,P=0.030), any ED visit (OR-3.33,P=0.008), 90-day readmission (OR-5.42,P=0.047) and any readmission (OR-5.41,P=0.005).
Conclusion:
Multivariable regression demonstrated that uncontrolled frailty was an independent risk factor for ED visits and readmission after single-level lumbar fusion. Further work is needed to identify the best pre- and postoperative strategies to optimize outcomes for this vulnerable population.
Insights
Uncontrolled frailty significantly increases the risk of emergency department visits and readmissions following lumbar fusion surgery. This highlights the need for targeted strategies to improve outcomes for frail patients undergoing spinal fusion.
Area of Science:
- Spine Surgery
- Orthopedics
- Patient Outcomes
Background:
- The modified frailty index (mFI-5) is a valuable tool for predicting postoperative risk, outperforming age alone.
- Sub-stratifying the mFI-5 into controlled versus uncontrolled frailty enhances risk prognostication, particularly in spinal deformity cases.
Purpose of the Study:
- To evaluate the impact of controlled versus uncontrolled frailty, as defined by the mFI-5, on postoperative outcomes after elective lumbar fusion for degenerative disease.
- To determine if sub-stratification of frailty status influences patient outcomes in this surgical cohort.
Main Methods:
- A retrospective cohort study included adult patients undergoing elective single-level lumbar fusion between 2017 and 2021.
- Patients were categorized as frail (based on mFI-5 criteria) or non-frail, with frail patients further classified as controlled or uncontrolled based on specific clinical parameters (e.g., COPD exacerbation, HbA1c, hypertension control).
- Exclusion criteria included fusions for infection, trauma, tumor, or revision surgery.
Main Results:
- Uncontrolled frailty was associated with significantly higher rates of 31-90 day emergency department (ED) visits, 0-30 day readmissions, and renal complications compared to controlled frailty.
- Multivariable regression identified uncontrolled frailty as an independent risk factor for 30-day ED visits, any ED visit, 90-day readmission, and any readmission.
- Controlled frailty patients were older and had more 0-30 day ED visits than non-frail patients, while uncontrolled frailty patients exhibited higher rates across multiple adverse outcomes compared to non-frail patients.
Conclusions:
- Uncontrolled frailty is an independent predictor of increased emergency department visits and readmissions after single-level lumbar fusion.
- Further research is warranted to develop optimal pre- and postoperative management strategies for frail patients undergoing lumbar fusion to mitigate these risks.
