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Frailty (mFI-5) and Age Predict Medical Complications After Posterior Lumbar Interbody Fusion in Older Adults: A
Jong-Hoon Jung1, Jong-Hwan Hong1, Ji-Ho Jung1
1Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju 61469, Republic of Korea.
Abstract:
Objective: To evaluate the prognostic utility of the five-item modified Frailty Index (mFI-5) for postoperative outcomes in older adults undergoing posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease and to develop an interpretable preoperative risk model for medical complications (CxME). Methods: We retrospectively reviewed consecutive patients aged ≥65 years who underwent PLIF for lumbar spondylosis at a single tertiary institution. Baseline demographics, comorbidities, symptoms, American Society of Anesthesiologists (ASA) physical status, bone mineral density, antithrombotic use, perioperative laboratory findings, and operative variables were collected. CxME were defined as Clavien-Dindo grade ≥ II complications occurring during index hospitalization or within 30 days postoperatively. mFI-5 was calculated from five preoperative variables and stratified as 0, 1, and ≥2. Multivariable logistic regression was used to identify independent predictors of CxME. Results: Among 255 patients (mean age 72.6 years), 53 (20.8%) developed CxME. Patients with CxME were older and had higher rates of diabetes mellitus and preoperative dependency. mFI-5 ≥ 2 was more frequent in patients with CxME than in those without (66.0% vs. 27.3%, p < 0.001). Higher frailty was associated with older age, greater comorbidity burden, higher ASA class, lower preoperative hemoglobin, greater transfusion exposure, longer hospital stay, and a higher incidence of CxME (14.0%, 9.6%, and 38.9% for mFI-5 scores 0, 1, and ≥2, respectively; p < 0.001). In multivariable analysis, age (OR 1.133, 95% CI 1.055-1.216; p < 0.001) and mFI-5 (OR 2.103, 95% CI 1.387-3.188; p < 0.001) independently predicted CxME. The Age + mFI-5 model showed fair discrimination (optimism-corrected area under ROC 0.734). Conclusions: Preoperative frailty and age independently predicted postoperative medical complications after PLIF in older adults. The Age + mFI-5 model may support risk stratification, counselling, and perioperative optimization.
Insights
Preoperative frailty, measured by the modified Frailty Index (mFI-5), and age independently predict medical complications after posterior lumbar interbody fusion (PLIF) in older adults. An Age + mFI-5 model aids risk stratification for better patient outcomes.
Area of Science:
- Geriatric Surgery
- Spine Surgery Outcomes
- Frailty Assessment
Background:
- Older adults undergoing posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease face significant risks of postoperative medical complications.
- Accurate preoperative risk stratification is crucial for optimizing patient selection, counseling, and perioperative management in this population.
- The five-item modified Frailty Index (mFI-5) is a potential tool for assessing frailty, but its prognostic utility in PLIF requires evaluation.
Purpose of the Study:
- To assess the prognostic value of the mFI-5 for predicting postoperative medical complications (CxME) in elderly patients undergoing PLIF.
- To develop and validate an interpretable preoperative risk model for CxME following PLIF.
- To identify key predictors of postoperative medical complications in this patient cohort.
Main Methods:
- Retrospective review of 255 patients aged ≥65 years who underwent PLIF for lumbar spondylosis.
- Data collected included demographics, comorbidities, ASA physical status, and operative variables.
- Medical complications (CxME) were defined as Clavien-Dindo grade ≥ II. The mFI-5 was calculated, and multivariable logistic regression identified predictors of CxME. An Age + mFI-5 model was developed.
Main Results:
- Of 255 patients, 53 (20.8%) experienced CxME. Older age and higher mFI-5 scores were significantly associated with increased complication rates.
- Independent predictors of CxME were older age (OR 1.133) and higher mFI-5 scores (OR 2.103).
- The developed Age + mFI-5 model demonstrated fair discrimination (optimism-corrected AUC 0.734).
Conclusions:
- Preoperative frailty (mFI-5) and age are independent predictors of postoperative medical complications after PLIF in older adults.
- The Age + mFI-5 risk model provides a valuable tool for stratifying patient risk.
- This model can enhance preoperative counseling and guide perioperative optimization strategies for elderly patients undergoing PLIF.
