J Korean Neurosurg Soc.  2020 Nov;63(6):827-833. 10.3340/jkns.2020.0019.

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

Affiliations
  • 1Department of Anesthesiology, Pain and Critical Care Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
  • 2Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
  • 3Department of Neurosurgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
  • 4Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
  • 5Department of Anesthesiology, Pain and Critical Care Medicine, Yeouido St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea

Abstract


Objective
: Spine surgery is associated with higher morbidity and mortality rates in elderly patients. The modified Frailty Index (mFI) is an evaluation tool to determine the frailty of an individual and how preoperative status may impact postoperative survival and outcomes. This study aimed to determine the usefulness of mFI in predicting postoperative complications in patients aged ≥75 years undergoing surgery with instrumentation.
Methods
: We retrospectively reviewed the perioperative course of 137 patients who underwent thoracolumbar-instrumentation spine surgery between 2011 and 2016. The preoperative risk factors were the 11 variables of the mFI, as well as body mass index (kg/cm2), preoperative hemoglobin, platelet, albumin, creatinine, anesthesia time, operation time, estimated blood loss, and transfusion amount. The 60-day occurrences of complication rates were used for outcome assessment.
Results
: Major complications after spinal instrumentation surgery occurred in 34 of 138 patients (24.6%). The mean mFI score was 0.18±0.12. When we divided patients into a pre-frail group (mFI, 0.09–0.18; n=94) and a frail group (mFI ≥0.27; n=44), only the rate of sepsis was statistically higher in the frail group than in the pre-frail group. There were significantly more major complications in patients with low albumin levels or in patients with infection or who had experienced trauma. The mFI was a more useful predictor of postoperative complications than the American Society of Anesthesiologists physical status score.
Conclusion
: The mFI can successfully predict postoperative morbidity and mortality in patients aged ≥75 years undergoing spine surgery. The mFI improves perioperative risk stratification that provides important information to assist in the preoperative counselling of patients and their families.

Keyword

Frail elderly; Risk assessment; Postoperative complications; Morbidity; Spine

Cited by  1 articles

Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease
Dong Uk Kim, Hyung Ki Park, Gyeoung Hae Lee, Jae Chil Chang, Hye Ran Park, Sukh Que Park, Sung Jin Cho
J Korean Neurosurg Soc. 2021;64(6):995-1003.    doi: 10.3340/jkns.2021.0074.


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