Key result
In patients aged 80 and older undergoing instrumented lumbar fusion, the MFI-11 frailty score was significantly associated with 30-day adverse events (OR 1.46; 95% CI 1.07-2.00; P=.018).
Why the study?
Age alone has limited predictive value for outcomes among older patients undergoing instrumented lumbar fusion, and the most predictive frailty score for adverse events in patients aged 80 and older was unknown.
Do frailty scores (MFI-5, MFI-11, CCI) predict 30-day adverse events in patients aged 80 and older undergoing instrumented lumbar fusion?
Observational (n=153)
Yes
Do frailty scores (MFI-5, MFI-11, CCI) predict 30-day adverse events in patients aged 80 and older undergoing instrumented lumbar fusion?
Odds Ratio: 1.46 (95% CI 1.07–2)
p-value: p=.018
In octogenarians undergoing instrumented lumbar fusion, the MFI-11 frailty score correlates with 30-day adverse events, though the overall predictive ability of existing frailty scores remains limited.
MFI-11 may inform preoperative counseling in octogenarian fusion patients; leaves open whether frailty scores meaningfully improve risk stratification.
BACKGROUND AND OBJECTIVES: Degenerative spine disease is a leading cause of disability, with increasing prevalence in the older patients. While age has been identified as an independent predictor of outcomes, its predictive value is limited for similar older patients. Here, we aimed to determine the most predictive frailty score of adverse events in patients aged 80 and older undergoing instrumented lumbar fusion. METHODS: We proceeded with a multisite (3 tertiary academic centers) retrospective review including patients undergoing instrumented fusion aged 80 and older from January 2010 to present. A composite end point encompassing 30-day return to operating room, readmission, and mortality was created. We estimated the area under the receiver operating characteristic curve for frailty scores (Modified Frailty Index-5 [MFI-5], Modified Frailty Index-11 [MFI-11], and Charlson Comorbidity Index [CCI]) in relation to that composite score. In addition, we estimated the association between each score and the composite end point by means of logistic regression. RESULTS: A total of 153 patients with an average age of 85 years at the time of surgery were included. We observed a 30-day readmission rate of 11.1%, reoperation of 3.9%, and mortality of 0.6%. The overall rate of the composite end point at 30 days was 25 (15.1%). The AUC for MFI-5 was 0.597 (0.501-0.693), for MFI-11 was 0.620 (0.518-0.723), and for CCI was 0.564 (0.453-0.675). The association between the scores and composite end point did not reach statistical significance for MFI-5 (odds ratio [OR] = 1.45 [0.98-2.15], P = .061) and CCI (OR = 1.13 [0.97-1.31], P = .113) but was statistically significant for MFI-11 (OR = 1.46 [1.07-2.00], P = .018). CONCLUSION: This is the largest study comparing frailty index scores in octogenarians undergoing instrumented lumbar fusion. Our findings suggest that while MFI-11 score correlated with adverse events, the predictive ability of existing scores remains limited, highlighting the need for better approaches to identify select patients at age extremes.
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Moniz‐Garcia et al. (2024) conducted an observational in Degenerative spine disease (n=153). Modified Frailty Index-11 (MFI-11) was evaluated on Composite end point encompassing 30-day return to operating room, readmission, and mortality (OR 1.46, 95% CI 1.07-2.00, p=.018). In patients aged 80 and older undergoing instrumented lumbar fusion, the MFI-11 frailty score was significantly associated with 30-day adverse events (OR 1.46; 95% CI 1.07-2.00; P=.018).
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