Prediction of Risk Factors after Spine Surgery in Patients Aged >75 Years Using the Modified Frailty Index

Abstract The simplified 5-factor modified frailty index (mFI-5) is a useful indicator of outcome for patients undergoing surgeries and considered as an important risk factor in elderly patients. However, its usefulness has not been validated based on age groups. We aimed to investigate the risk factors including the mFI-5 across age groups for complications and worse outcomes in meningioma surgery using data obtained from the nationwide database in Japan. We extracted data from the nationwide registry database in Japan between 2010 and 2015. Age (< 65, 65–74, and ≥ 75 years), sex, Barthel Index (BI), mFI-5 scores, and complications were evaluated. Multivariate logistic regression analyses identified risk factors across all age groups for worsening BI scores and complications after surgery. In 8,138 included cases, an mFI-5 score ≥ 2 items was a significant risk factor for worsening BI scores in patients aged < 65 years (odds ratio: 2.00; 95% confidence interval: 1.31-3.06), but not in patients aged 65-74 years and those aged ≥ 75 years. Similar results were noted for complications in patients aged < 65 years (2.40; 1.67–3.44), but not in patients aged 65-74 years and those aged ≥ 75 years. In conclusion, the mFI-5 scores can predict the risk of worsening outcome and complications in non-elderly patients aged < 65 years rather than in elderly patients aged ≥ 65 years. In meningioma surgeries, care must be taken when making decisions using the mFI-5 scores based on the patients’ age.Trial RegistrationName: Study on treatment method, age group, complications, and outcome of meningiomas and hemangioblastomas using DPC, URL: http://www.umin.ac.jp/ctr/index-j.htmID: UMIN000038486, No.: R000043856

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

Spine ◽

10.1097/brs.0000000000003936 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Katherine E. Pierce ◽

Sara Naessig ◽

Nicholas Kummer ◽

Kylan Larsen ◽

Waleed Ahmad ◽

...

Keyword(s):

Postoperative Complications ◽

Spine Surgery ◽

Frailty Index ◽

Modified Frailty Index

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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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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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Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2010.12.017 ◽

2011 ◽

Vol 2011 ◽

pp. 283-284

Author(s):

R. Riesenburger

Keyword(s):

Risk Factors ◽

Cerebral Palsy ◽

Infection Rate ◽

Spine Surgery ◽

Multicenter Analysis

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Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room

Journal of Tissue Viability ◽

10.1016/j.jtv.2021.06.006 ◽

2021 ◽

Author(s):

Mi Ae Choi ◽

Myoung Soo Kim ◽

Cheol Kim

Keyword(s):

Risk Factors ◽

Operating Room ◽

Medical Device ◽

Prone Position ◽

Spine Surgery

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Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

World Journal of Urology ◽

10.1007/s00345-020-03556-7 ◽

2021 ◽

Author(s):

M. T. Walach ◽

M. F. Wunderle ◽

N. Haertel ◽

J. K. Mühlbauer ◽

K. F. Kowalewski ◽

...

Keyword(s):

Active Surveillance ◽

Surgical Outcome ◽

Frailty Index ◽

Treatment Decision ◽

Solitary Kidney ◽

Tumor Ablation ◽

Renal Masses ◽

Skeletal Muscle Index ◽

Decision Tools ◽

Modified Frailty Index

Abstract Purpose To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). Methods Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). Results Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. Conclusion In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

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