Medical Student Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
Introduction: Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure for degenerative conditions of the cervical spine. While frailty has emerged as a key predictor of adverse surgical outcomes in ACDF, and multilevel procedures (≥3 levels) carry increased risk, the relationship between frailty measures and outcomes in multilevel ACDF remains unclear. This study examines how two frailty indices, mFI-5 and CCI, correlate with extended length of stay (LOS >75th percentile), 30-day readmission, and reoperation in a cohort of patients undergoing 3-level ACDF.
Methods: In this retrospective, single-center study, we analyzed 137 patients who underwent 3-level ACDF between 2013 and 2023. Patients were stratified by modified 5-factor frailty index scores into Not-frail (mFI-5 = 0), Pre-frail (mFI-5 = 1), and Frail (mFI-5 ≥ 2). CCI was analyzed as a continuous variable. Using multivariable logistic regression adjusted for age, race, sex, ethnicity, and BMI, we examined associations between frailty indices and extended length of stay (LOS >75th percentile), 30-day readmission, and reoperation.
Results: The sample had a mean age of 60 years (IQR: 52-69), and 48% were female. Frail patients (mFI-5 ≥ 2) demonstrated a significant correlation with extended LOS (OR: 6.95; 95% CI: 1.37-35.3; p=0.019). Similarly, increasing CCI was significantly associated with extended LOS (OR: 1.84; 95% CI: 1.33-2.56; p=0.0025). However, neither frailty measure demonstrated significant association with readmission or reoperation risk.
Conclusion : In this 3-level ACDF cohort, Frail patients (mFI-5 scores ≥ 2) and increased CCI were identified as significant predictors of extended LOS. However, neither frailty measure reliably predicted readmission or reoperation. These results suggest that while frailty indices like mFI-5 and CCI can help identify patients at higher risk for prolonged hospitalization, they may be less useful for predicting readmission and reoperation in 3-level ACDF patients.