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

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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Editorial: The utility of the modified frailty index for risk stratification in patients undergoing spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2016.1.spine151261 ◽

2016 ◽

Vol 25 (4) ◽

pp. 535-536 ◽

Cited By ~ 4

Author(s):

Charles Fisher ◽

Jin Tee

Keyword(s):

Risk Stratification ◽

Spine Surgery ◽

Frailty Index ◽

Modified Frailty Index

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167 THE ENHANCED MODIFIED FRAILTY INDEX SCORE IS A BETTER PREDICTOR FOR POSTOPERATIVE MORBIDITY AND MORTALITY AFTER WHIPPLE PROCEDURE COMPARED TO MODIFIED FRAILTY INDEX SCORE

Gastroenterology ◽

10.1016/s0016-5085(20)34394-8 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1492

Author(s):

Konstantinos A. Zorbas ◽

Lois A. William ◽

Daniel T. Farkas ◽

Ajay Shah ◽

Vic Velanovich ◽

...

Keyword(s):

Postoperative Morbidity ◽

Frailty Index ◽

Whipple Procedure ◽

Index Score ◽

Morbidity And Mortality ◽

Modified Frailty Index

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MP63-01 MODIFIED FRAILTY INDEX PREDICTS MORTALITY AND ADVERSE OUTCOMES IN PATIENTS UNDERGOING RENAL SURGERY: ANALYSIS OF THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE

The Journal of Urology ◽

10.1016/j.juro.2015.02.2333 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Jamie S. Pak ◽

Danny Lascano ◽

Julia B. Finkelstein ◽

Mark V. Silva ◽

G. Joel DeCastro ◽

...

Keyword(s):

Quality Improvement ◽

Frailty Index ◽

Adverse Outcomes ◽

Quality Improvement Program ◽

Renal Surgery ◽

Improvement Program ◽

Surgical Quality ◽

Modified Frailty Index

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Adapting the 5-factor modified frailty index for prediction of postprocedural outcome in patients with unruptured aneurysms

Journal of Neurosurgery ◽

10.3171/2021.2.jns204420 ◽

2021 ◽

pp. 1-8

Author(s):

James Feghali ◽

Abhishek Gami ◽

Sarah Rapaport ◽

Jaimin Patel ◽

Adham M. Khalafallah ◽

...

Keyword(s):

Treatment Outcomes ◽

Frailty Index ◽

Multivariable Analysis ◽

Unruptured Aneurysm ◽

Improvement Program ◽

Unruptured Aneurysms ◽

Major Complications ◽

C Statistic ◽

Physical Status Classification ◽

Modified Frailty Index

OBJECTIVE The 5-factor modified frailty index (mFI-5) is a practical tool that can be used to estimate frailty by measuring five accessible factors: functional status, history of diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension. The authors aimed to validate the utility of mFI-5 for predicting endovascular and microsurgical treatment outcomes in patients with unruptured aneurysms. METHODS A prospectively maintained database of consecutive patients with unruptured aneurysm who were treated with clip placement or endovascular therapy was used. Because patient age is an important predictor of treatment outcomes in patients with unruptured aneurysm, mFI-5 was supplemented with age to create the age-supplemented mFI-5 (AmFI-5). Associations of scores on these indices with major complications (symptomatic ischemic or hemorrhagic stroke, pulmonary embolism, pneumonia, or surgical site infection requiring reoperation) were evaluated. Validation was carried out with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2006–2017). RESULTS The institutional database included 275 patients (88 underwent clip placement, and 187 underwent endovascular treatment). Multivariable analysis of the surgical cohort showed that major complication was significantly associated with mFI-5 (OR 2.0, p = 0.046) and AmFI-5 (OR 1.9, p = 0.028) scores. Significant predictive accuracy for major complications was provided by mFI-5 (c-statistic = 0.709, p = 0.011) and AmFI-5 (c-statistic = 0.720, p = 0.008). The American Society of Anesthesiologists Physical Status Classification System (ASA) provided poor discrimination (area under the curve = 0.541, p = 0.618) that was significantly less than that of mFI-5 (p = 0.023) and AmFI-5 (p = 0.014). Optimal relative fit was achieved with AmFI-5, which had the lowest Akaike information criterion value. Similar results were obtained after equivalent analysis of the endovascular cohort, with additional significant associations between index scores and length of stay (β = 0.6 and p = 0.009 for mFI-5; β = 0.5 and p = 0.003 for AmFI-5). In 1047 patients who underwent clip placement and were included in the NSQIP database, mFI-5 (p = 0.001) and AmFI-5 (p < 0.001) scores were significantly associated with severe postoperative adverse events and provided greater discrimination (c-statistic = 0.600 and p < 0.001 for mFI-5; c-statistic = 0.610 and p < 0.001 for AmFI-5) than ASA score (c-statistic = 0.580 and p = 0.003). CONCLUSIONS mFI-5 and AmFI-5 represent potential predictors of procedure-related complications in unruptured aneurysm patients. After further validation, integration of these tools into clinical workflows may optimize patients for intervention.

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Frailty Predicts Morbidity and Mortality after Colectomy for Clostridium difficile Colitis

The American Surgeon ◽

10.1177/000313481808400511 ◽

2018 ◽

Vol 84 (5) ◽

pp. 628-632

Author(s):

Raghunandan Venkat ◽

Viraj Pandit ◽

Edwin Telemi ◽

Oleksandr Trofymenko ◽

Twinkle K. Pandian ◽

...

Keyword(s):

Clostridium Difficile ◽

Frailty Index ◽

Length Of Hospital Stay ◽

Morbidity And Mortality ◽

Class Iii ◽

Improvement Program ◽

Surgical Quality ◽

Prolonged Length ◽

Increased Risk ◽

Clostridium Difficile Colitis

Frailty has been noted as a powerful predictive preoperative tool for 30-day postoperative complications. We sought to evaluate the association between frailty and postoperative outcomes after colectomy for Clostridium difficile colitis. The National Surgical Quality and Improvement Program cross-institutional database was used for this study. Data from 470 patients with a diagnosis of C. difficile colitis were used in the study. Modified frailty index (mFI) is a previously described and validated 11-variable frailty measure used with the National Surgical Quality and Improvement Program to assess frailty. Outcome measures included serious morbidity, overall morbidity, and Clavien IV (requiring ICU) and Clavien V (mortality) complications. The median age was 70 years and body mass index was 26.9 kg/m2. 55.6 per cent of patients were females. 98.5 per cent of patients were assigned American Society of Anesthesiologists Class III or higher. The median mFI was 0.27 (0–0.63). Because mFI increased from 0 (non-frail) to 0.55 and above, the overall morbidity increased from 53.3 per cent to 84.4 per cent and serious morbidity increased from 43.3 per cent to 78.1 per cent. The Clavien IV complication rate increased from 30.0 per cent to 75.0 per cent. The mortality rate increased from 6.7 per cent to 56.2 per cent. On a multivariate analysis, mFI was an independent predictor ofoverall morbidity (AOR: 13.0; P < 0.05), mortality (AOR: 8.8; P = 0.018), cardiopulmonary complications (AOR: 6.8; P = 0.026), and prolonged length of hospital stay (AOR: 6.6; P = 0.045). Frailty is associated with increased risk of complications in C. difficile colitis patients undergoing colectomy. mFI is an easy-to-use tool and can play an important role in the risk stratification of these patients who generally have significant morbidity and mortality to begin with.

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