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The Modified 5-Item Frailty Index as a Predictor of Postoperative Complications in Patients Undergoing Spinal
Gonzalo Kido1, Nicolas Molho1, Patricio Encinar1
1Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Abstract:
Study DesignRetrospective cohort study.ObjectiveTo evaluate the predictive performance (discrimination and calibration) of the mFI-5 for major postoperative complications in thoracolumbar spine surgery, and to compare its effectiveness in low-, moderate-, and high-complexity procedures.MethodsThe study was conducted on adult patients (>18 years) who underwent thoracolumbar spine surgery at a single tertiary care center between 2017 and 2020. The primary outcome was the incidence of major complications within 90 days. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUROC), and calibration was evaluated with calibration-in-the-large (CITL), calibration slope, and the Hosmer-Lemeshow test.ResultsA total of 839 patients were included (mean age: 62.8 years; SD: 16.8). Major complications occurred in 8.2% of cases. The mFI-5 demonstrated fair discrimination (AUROC: 0.66; 95% CI: 0.60-0.70) and excellent calibration (slope = 1, CITL = 0; Hosmer-Lemeshow P = .99). Stratified analysis showed improved discrimination in high-complexity surgeries (AUROC: 0.74; 95% CI: 0.64-0.84), compared to moderate (0.62; 95% CI: 0.48-0.74) and low complexity (0.63; 95% CI: 0.50-0.74) procedures. Readmission rates were 7% at 30 days and 9% at 90 days, with a 6-month mortality rate of 1%.ConclusionThe mFI-5 is a valuable tool for predicting major complications in thoracolumbar spine surgery, particularly in high-complexity procedures. Its predictive performance is limited in lower-complexity surgeries. Further prospective studies are needed to validate its use and enhance preoperative risk stratification.
Insights
The modified Frailty Index (mFI-5) predicts major complications in thoracolumbar spine surgery, showing better accuracy for high-complexity procedures. Further research is needed to validate its use in lower-complexity cases.
Area of Science:
- Spine Surgery
- Surgical Outcomes
- Predictive Analytics
Background:
- Major postoperative complications pose significant risks in thoracolumbar spine surgery.
- Accurate preoperative risk stratification is crucial for patient management and resource allocation.
Purpose of the Study:
- To evaluate the predictive performance of the modified Frailty Index with 5 items (mFI-5) for major postoperative complications.
- To compare the mFI-5's effectiveness across low-, moderate-, and high-complexity thoracolumbar spine procedures.
Main Methods:
- Retrospective cohort study of 839 adult patients undergoing thoracolumbar spine surgery (2017-2020).
- Assessed mFI-5 discrimination using AUROC and calibration via CITL, slope, and Hosmer-Lemeshow test.
- Analyzed outcomes including major complications within 90 days, readmissions, and mortality.
Main Results:
- The mFI-5 demonstrated fair discrimination (AUROC: 0.66) and excellent calibration for predicting major complications (8.2% incidence).
- Predictive performance was superior in high-complexity surgeries (AUROC: 0.74) compared to moderate (0.62) and low (0.63) complexity procedures.
- 30-day readmission was 7%, 90-day readmission was 9%, and 6-month mortality was 1%.
Conclusions:
- The mFI-5 is a valuable tool for predicting major complications in thoracolumbar spine surgery, especially for high-complexity cases.
- Its predictive utility is diminished in lower-complexity procedures.
- Prospective studies are recommended to validate the mFI-5 and improve preoperative risk assessment.
