Medical Student Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
Introduction: The modified frailty index (mFI-5) is commonly used to assess frailty and predict postoperative outcomes. Prior studies have shown mFI-5 to be correlated with adverse outcomes in anterior cervical discectomy and fusion (ACDF) patients. However, the predictive value of mFI-5 in patients undergoing multilevel ACDF (≥3 levels) is not well established. This study examines whether mFI-5 predicts adverse postoperative outcomes in patients undergoing multilevel ACDF.
Methods: This retrospective analysis reviewed 2,904 patients who underwent multilevel ACDF from 2015 to 2020 using the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified by mFI-5 score into three groups: Not-frail (mFI-5 = 0), Pre-frail (mFI-5 = 1), and Frail (mFI-5 ≥ 2). Cox proportional hazards models, adjusted for demographics, comorbidities, and surgical characteristics, assessed associations between mFI-5 groups and outcomes, including non-routine discharge, extended length of stay (LOS >75th percentile), readmission, reoperation, any complication, and severe complication.
Results: The sample had a mean age of 59.3 years (SD 10.1), and 49.9% were female. There were no significant associations between higher mFI-5 scores and adverse postoperative outcomes, including non-routine discharge (Pre-frail, p=0.71; Frail, p=0.20), extended LOS (Pre-frail, p=0.06; Frail, p=0.96), readmission (Pre-frail, p=0.94; Frail, p=0.97), reoperation (Pre-frail, p=0.33; Frail, p=0.28), any complication (Pre-frail, p=0.84; Frail, p=0.95), or severe complication (Pre-frail, p=0.61; Frail, p=0.69).
Conclusion : For patients undergoing multilevel ACDF, the mFI-5 does not predict non-routine discharge, extended LOS, readmission, reoperation, any complication, or severe complication. These findings question the utility of frailty, as assessed by mFI-5, in surgical risk stratification for multilevel ACDF, suggesting a need for alternative or supplementary predictive measures in this patient population.