The 5-Item Modified Frailty Index is Predictive of 30-Day Postoperative Complications in Patients Undergoing Spine Surgery

Category: Ankle, Trauma Introduction/Purpose: Frailty, a multifaceted syndrome resulting from a decrease in physiologic reserves, has been previously shown to play a significant role in elderly morbidity and mortality. The literature on frailty within orthopaedic surgery is limited currently. No study to date has assessed frailty as a predictor of postoperative outcomes in elderly patients with ankle fractures. We hypothesized that increasing frailty would be associated with increased 30-day reoperation rates and increased postoperative complications. Methods: The National Surgical Quality Improvement Project (NSQIP) was queried using the appropriate CPT codes to identify inpatients from 2005-2014 who were aged 50 years and older that sustained an ankle fracture and underwent operative fixation. Frailty was assessed using a modified frailty index (MFI), abbreviated with 11 variables from the Canadian Study of Health and Aging Frailty Index. The primary outcome was 30-day reoperation rate and secondary outcomes were postoperative surgical and medical complications, readmission rates, and length of stay. Bivariate and multivariate analysis was used to determine association between outcomes and MFI. Results: 6,749 patients were identified, and the mean age of these patients was 64.4 years. Patients with increased MFI scores had significantly higher rates of postoperative complications. In addition, increased MFI scores was also associated with increased 30 day readmissions and reoperations. Multivariate analysis also demonstrated that MFI was a stronger predictor of 30 day reoperation rates (odds ratio of 17.7, P < 0.001) than age, wound class, and ASA class. Conclusion: Frailty has the potential to be an important predictive variable of postoperative outcomes in patients aged 50 years and older who sustain ankle fractures. The modified frailty index can be a valuable preoperative risk assessment tool for the orthopaedic surgeon. Further study is necessary to examine the effect of the MFI in a larger prospective setting.

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Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2015.10.spine14582 ◽

2016 ◽

Vol 25 (4) ◽

pp. 537-541 ◽

Cited By ~ 97

Author(s):

Rushna Ali ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

Heath J. Antoine ◽

Ilan Rubinfeld

Keyword(s):

Risk Stratification ◽

Spine Surgery ◽

Postoperative Morbidity ◽

Frailty Index ◽

Surgical Site Infections ◽

Perioperative Risk ◽

Morbidity And Mortality ◽

Improvement Program ◽

Gastrointestinal Problems ◽

Modified Frailty Index

OBJECTIVE Limited tools exist to stratify perioperative risk in patients undergoing spinal procedures. The modified frailty index (mFI) based on the Canadian Study of Health and Aging Frailty Index (CSHA-FI), constructed from standard demographic variables, has been applied to various other surgical populations for risk stratification. The authors hypothesized that it would be predictive of postoperative morbidity and mortality in patients undergoing spine surgery. METHODS The 2006–2010 National Surgical Quality Improvement Program (NSQIP) data set was accessed for patients undergoing spine surgeries based on Current Procedural Terminology (CPT) codes. Sixteen preoperative clinical NSQIP variables were matched to 11 CSHA-FI variables (changes in daily activities, gastrointestinal problems, respiratory problems, clouding or delirium, hypertension, coronary artery and peripheral vascular disease, congestive heart failure, and so on). The outcomes assessed were 30-day occurrences of adverse events. These were then summarized in groups: any infection, wound-related complication, Clavien IV complications (life-threatening, requiring ICU admission), and mortality. RESULTS A total of 18,294 patients were identified. In 8.1% of patients with an mFI of 0 there was at least one morbid complication, compared with 24.3% of patients with an mFI of ≥ 0.27 (p < 0.001). An mFI of 0 was associated with a mortality rate of 0.1%, compared with 2.3% for an mFI of ≥ 0.27 (p < 0.001). Patients with an mFI of 0 had a 1.7% rate of surgical site infections and a 0.8% rate of Clavien IV complications, whereas patients with an mFI of ≥ 0.27 had rates of 4.1% and 7.1% for surgical site infections and Clavien IV complications, respectively (p < 0.001 for both). Multivariate analysis showed that the preoperative mFI and American Society of Anesthesiologists classification of ≥ III had a significantly increased risk of leading to Clavien IV complications and death. CONCLUSIONS A higher mFI was associated with a higher risk of postoperative morbidity and mortality, providing an additional tool to improve perioperative risk stratification.

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Risk Stratification of Elderly Patients Undergoing Spinal Surgery Using the Modified Frailty Index

Global Spine Journal ◽

10.1177/2192568221999650 ◽

2021 ◽

pp. 219256822199965

Author(s):

Barry Ting Sheen Kweh ◽

Hui Qing Lee ◽

Terence Tan ◽

Kim Siong Tew ◽

Ronald Leong ◽

...

Keyword(s):

Risk Stratification ◽

Elderly Patients ◽

Surgical Site Infection ◽

Spine Surgery ◽

Complication Rate ◽

Frailty Index ◽

Major Complication ◽

Site Infection ◽

Modified Frailty Index ◽

Major Complication Rate

Study Design: Retrospective cohort. Objectives: To validate the 11-item modified Frailty Index (mFI) as a perioperative risk stratification tool in elderly patients undergoing spine surgery. Methods: All consecutive cases of spine surgery in patients aged 65 years or older between July 2016 and June 2018 at a state-wide trauma center were retrospectively reviewed. The primary outcome was post-operative major complication rate (Clavien-Dindo Classification ≥ III). Secondary outcome measures included the rate of all complications, 6-month mortality and surgical site infection. Results: A total of 348 cases were identified. The major complication rate was significantly lower in patients with an mFI of 0 compared to ≥ 0.45 (18.3% versus 42.5%, P = .049). As the mFI increased from 0 to ≥ 0.45 there was a stepwise increase in risk of major complications ( P < .001). Additionally, 6-month mortality rate was considerably lower when the mFI was 0 rather than ≥ 0.27 (4.2% versus 20.4%, P = .007). Multivariate analysis demonstrated an mFI ≥ 0.27 was significantly associated with an increased incidence of major complication (OR 2.80, 95% CI 1.46-5.35, P = .002), all complication (OR 2.93, 95% CI 1.70-15.11, P < .001), 6-month mortality (OR 7.39, 95% CI 2.55-21.43, P < .001) and surgical site infection (OR 4.43, 95% CI 1.71-11.51, P = .002). The American Society of Anesthesiologists’ (ASA) index did not share a stepwise relationship with any outcome. Conclusion: The mFI is significantly associated in a gradated fashion with increased morbidity and mortality. Patients with an mFI ≥ 0.27 are at greater risk of major complications, all-complications, 6-monthy mortality, and surgical site infection.

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The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation

World Neurosurgery ◽

10.1016/j.wneu.2018.04.172 ◽

2018 ◽

Vol 116 ◽

pp. e225-e231 ◽

Cited By ~ 24

Author(s):

Dale N. Segal ◽

Jacob M. Wilson ◽

Christopher Staley ◽

Keith W. Michael

Keyword(s):

Postoperative Complications ◽

Frailty Index ◽

Vertebral Augmentation ◽

Modified Frailty Index

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Impact of modified Frailty Index-11 (mFI-11) on postoperative complications in patients undergoing transsphenoidal resection of pituitary tumors: Analysis of 2006–2014 ACS-NSQIP database

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.07.046 ◽

2021 ◽

Vol 92 ◽

pp. 22-26

Author(s):

Sarah Nguyen ◽

Robert B. Kim ◽

Parker Cox ◽

Nicholas T. Gamboa ◽

Michael Karsy ◽

...

Keyword(s):

Postoperative Complications ◽

Frailty Index ◽

Pituitary Tumors ◽

Acs Nsqip ◽

Modified Frailty Index ◽

Acs Nsqip Database ◽

Transsphenoidal Resection

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The composite risk index based on frailty predicts postoperative complications in older patients recovering from elective digestive tract surgery: a retrospective cohort study

BMC Anesthesiology ◽

10.1186/s12871-021-01549-6 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Chun-Qing Li ◽

Chen Zhang ◽

Fan Yu ◽

Xue-Ying Li ◽

Dong-Xin Wang

Keyword(s):

Cohort Study ◽

Postoperative Complications ◽

Digestive Tract ◽

Older Patients ◽

Retrospective Cohort ◽

Risk Index ◽

Frailty Index ◽

Modified Frailty Index ◽

Digestive Tract Surgery ◽

Composite Risk

Abstract Background Limitations exist in available studies investigating effect of preoperative frailty on postoperative outcomes. This study was designed to analyze the association between composite risk index, an accumulation of preoperative frailty deficits, and the risk of postoperative complications in older patients recovering from elective digestive tract surgery. Methods This was a retrospective cohort study. Baseline and perioperative data of older patients (age ≥ 65 years) who underwent elective digestive tract surgery from January 1, 2017 to December 31, 2018 were collected. The severity of frailty was assessed with the composite risk index, a composite of frailty deficits including modified frailty index. The primary endpoint was the occurrence of postoperative complications during hospital stay. The association between the composite risk index and the risk of postoperative complications was assessed with a multivariable logistic regression model. Results A total of 923 patients were included. Of these, 27.8% (257) developed postoperative complications. Four frailty deficits, i.e., modified frailty index ≥0.27, malnutrition, hemoglobin < 90 g/L, and albumin ≤30 g/L, were combined to generate a composite risk index. Multivariable analysis showed that, when compared with patients with composite risk index of 0, the odds ratios (95% confidence intervals) were 2.408 (1.714–3.383, P < 0.001) for those with a composite risk index of 1, 3.235 (1.985–5.272, P < 0.001) for those with a composite risk index of 2, and 9.227 (3.568–23.86, P < 0.001) for those with composite risk index of 3 or above. The area under receiver-operator characteristic curve to predict postoperative complications was 0.653 (95% confidence interval 0.613–0.694, P < 0.001) for composite risk index compared with 0.622 (0.581–0.663, P < 0.001) for modified frailty index. Conclusion For older patients following elective digestive tract surgery, high preoperative composite risk index, a combination of frailty deficits, was independently associated with an increased risk of postoperative complications.

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The Usefulness of the Modified Frailty Index for Muscle-Invasive Bladder Cancer Patients Treated with Radical Cystectomy

Current Urology ◽

10.1159/000499263 ◽

2020 ◽

Vol 14 (1) ◽

pp. 32-37 ◽

Cited By ~ 1

Author(s):

Maarten J.H. Voskamp ◽

Marloes Vermeer ◽

Gerd-Jan Molijn ◽

Erik B. Cornel

Keyword(s):

Postoperative Complications ◽

Confidence Interval ◽

Radical Cystectomy ◽

Treatment Options ◽

Frailty Index ◽

Multivariate Logistic Regression Analysis ◽

Good Alternative ◽

Chi Square ◽

Modified Frailty Index ◽

Muscle Invasive

Background: Radical cystectomy is still the gold standard for muscle-invasive bladder carcinoma (MIBC) treatment. In order to reduce postoperative complications, multimodality bladder-sparing therapies could be a good alternative. Studies in various malignancies have shown that the modified Frailty Index (mFI) may be more useful for identifying high-risk patients. Objectives: We investigated the possible correlation between the mFI in cystectomy patients with MIBC and serious complications 30 and 90 days postoperatively. Methods: Analysis of a prospective database of 109 consecutive MIBC patients who underwent a cystectomy between January 2012 and August 2017 was performed. The mFI was added retrospectively. Differences between groups were tested with independent t-tests, Mann-Whitney U tests, ANOVA, Kruskal-Wallis test, or Chi square tests as appropriate. Univariate and multivariate logistic regression analysis were performed to analyse the relation between the mFI and complications. Results: Patients with Clavien-Dindo ≥ 3 at 30 and 90 days postoperatively had a significantly higher mFI compared to patients with Clavien-Dindo < 3: the odds ratio of the mFI for serious complications within 30 days was 1.5 (95% confidence interval 1.1-2.1, p = 0.010) and for 90 days was 1.5 (95% confidence interval 1.1-2.1, p = 0.008). Conclusions: We found an association between a high mFI and postoperative complications and mortality. The mFI is therefore useful when discussing treatment options with MIBC patients.

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