Institutional members access full text with Ovid®

Share this article on:

Frailty Index as a Predictor of Adverse Postoperative Outcomes in Patients Undergoing Cervical Spinal Fusion

Shin, John I. BS; Kothari, Parth BS; Phan, Kevin BS; Kim, Jun S. MD; Leven, Dante DO, PT; Lee, Nathan J. BS; Cho, Samuel K. MD

doi: 10.1097/BRS.0000000000001755
Cervical Spine

Study Design. Retrospective study of prospectively collected data.

Objective. To investigate the applicability of the modified frailty index (mFI) as a predictor of adverse postoperative events in patients undergoing anterior cervical discectomy and fusion (ACDF) or posterior cervical fusion (PCF).

Summary of Background Data. Prior studies have investigated the mFI and shown it as an independent predictor of adverse postoperative outcomes across multiple surgical specialties. However, this topic has not still been studied in patients undergoing cervical fusion or in spinal surgery.

Methods. The National Surgical Quality Improvement Program is a multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent elective ACDF and PCF between 2005 and 2012. The mFI was calculated for each patient. Univariate analysis and multivariate logistic regression were used to analyze the mFI as a predictor for postoperative complications.

Results. For ACDF group, Clavien-Dindo grade IV complications rate increased from 0.8% to 9.0% as mFI increased from 0 to ≥0.27, and mFI = 0.27 was found to be an independent predictor of Clavien-Dindo grade IV complications (odds ratio, OR, = 4.67, 95% confidence interval, CI, = 2.27–9.62, P < 0.001). For PCF groups, Clavien-Dindo grade IV complications rate increased from 0.7% to 20.0% as mFI increased from 0 to ≥0.36, and mFI ≥ 0.36 was identified as an independent predictor of Clavien-Dindo grade IV complications (OR = 41.26, 95% CI = 6.62–257.15, P < 0.001).

Conclusion. The mFI was shown to be an independent predictor of Clavien-Dindo grade IV complications in patients undergoing ACDF or PCF. The mFI itself may be used to stratify risks in patients undergoing cervical fusion, or, the mFI scheme could be used as a platform upon which more efficient risk stratification could be done with addition of other variables.

Level of Evidence: 4

Supplemental Digital Content is available in the text

*Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

NeuroSpine Surgery Research Group, University of New South Wales, Sydney, Australia

Faculty of Medicine, University of New South Wales, Sydney, Australia.

Address correspondence and reprint requests to Samuel K. Cho, MD, Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1188, New York, NY 10029; E-mail: samuel.cho@mountsinai.org

Received 9 February, 2016

Revised 20 May, 2016

Accepted 2 June, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: Stryker grant, OREF grant.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.spinejournal.com).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.