Frailty as a Predictor of Postoperative Morbidity and Mortality in Patients Aged 80 Years and Older Undergoing Instrumented Fusion

Diogo Moniz-Garcia; Nour Odeh; Oktay Genel; Alaa Montaser; Bernardo Sousa-Pinto; Gaetano De Biase; Andrea Otamendi-Lopez; Eric Nottmeier; Mohamad Bydon; Jamal McClendon; Ian A Buchanan; Stephen Pirris; Kingsley Abode-Iyamah; Selby Chen

doi:10.1227/ons.0000000000001040

Frailty as a Predictor of Postoperative Morbidity and Mortality in Patients Aged 80 Years and Older Undergoing Instrumented Fusion

Oper Neurosurg (Hagerstown). 2024 Jan 8. doi: 10.1227/ons.0000000000001040. Online ahead of print.

Authors

Diogo Moniz-Garcia¹, Nour Odeh^{1

2}, Oktay Genel^{1

3}, Alaa Montaser¹, Bernardo Sousa-Pinto^{4

5}, Gaetano De Biase¹, Andrea Otamendi-Lopez¹, Eric Nottmeier¹, Mohamad Bydon⁶, Jamal McClendon⁷, Ian A Buchanan¹, Stephen Pirris¹, Kingsley Abode-Iyamah¹, Selby Chen¹

Affiliations

¹ Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
² College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
³ School of Medicine, King's College London, London, UK.
⁴ MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
⁵ CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.
⁶ Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Department of Neurologic Surgery, Mayo Clinic, Scottsdale, Arizona, USA.

PMID: 38189376
DOI: 10.1227/ons.0000000000001040

Abstract

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.