Key result
The mFI-5 predicts major spinal surgery complications with a 0.74 AUROC in high-complexity procedures.
Why the study?
To evaluate the predictive performance of the mFI-5 for major postoperative complications in thoracolumbar spine surgery across low-, moderate-, and high-complexity procedures.
Does the mFI-5 predict major postoperative complications in adult patients undergoing thoracolumbar spine surgery?
Does the mFI-5 predict major postoperative complications in adult patients undergoing thoracolumbar spine surgery?
The mFI-5 is a valuable tool for predicting major complications in high-complexity thoracolumbar spine surgery, but has limited predictive performance in lower-complexity procedures.
Answers are grounded in this paper and cite their sources.
mFI-5 may inform risk stratification before complex thoracolumbar surgery; extends frailty tools but leaves open better predictors for routine cases.
Study Design Retrospective cohort study. Objective To evaluate the predictive performance (discrimination and calibration) of the mFI-5 for major postoperative complications in thoracolumbar spine surgery, and to compare its effectiveness in low-, moderate-, and high-complexity procedures. Methods The study was conducted on adult patients (>18 years) who underwent thoracolumbar spine surgery at a single tertiary care center between 2017 and 2020. The primary outcome was the incidence of major complications within 90 days. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUROC), and calibration was evaluated with calibration-in-the-large (CITL), calibration slope, and the Hosmer-Lemeshow test. Results A total of 839 patients were included (mean age: 62.8 years; SD: 16.8). Major complications occurred in 8.2% of cases. The mFI-5 demonstrated fair discrimination (AUROC: 0.66; 95% CI: 0.60-0.70) and excellent calibration (slope = 1, CITL = 0; Hosmer-Lemeshow P = .99). Stratified analysis showed improved discrimination in high-complexity surgeries (AUROC: 0.74; 95% CI: 0.64-0.84), compared to moderate (0.62; 95% CI: 0.48-0.74) and low complexity (0.63; 95% CI: 0.50-0.74) procedures. Readmission rates were 7% at 30 days and 9% at 90 days, with a 6-month mortality rate of 1%. Conclusion The mFI-5 is a valuable tool for predicting major complications in thoracolumbar spine surgery, particularly in high-complexity procedures. Its predictive performance is limited in lower-complexity surgeries. Further prospective studies are needed to validate its use and enhance preoperative risk stratification.
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Kido et al. (2026) studied this question. The modified 5-item frailty index predicted major spinal surgery complications with an overall AUROC of 0.66, which improved to 0.74 for high-complexity procedures.
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