The 5-factor modified frailty index (mFI-5) is associated with non-routine discharge, length of stay, and time to complication for anterior cervical corpectomy and fusion (ACCF)
Medical Student Johns Hopkins University School of Medicine Johns Hopkins School of Medicine
Disclosure(s):
Ritvik R. Jillala, BSE: No financial relationships to disclose
Introduction: Anterior cervical corpectomy and fusion (ACCF) is a surgical procedure employed for removing damaged vertebrae and decompressing the spinal cord. The 5-factor modified frailty index (mFI-5) has emerged as a valuable tool for predicting adverse outcomes and length of stay in various spine procedures. This study aims to characterize the association between mFI-5 andf non-routine discharge, length of stay (LOS), time to complication, readmission, and reoperation for ACCF using the National Surgical Quality Improvement Program (NSQIP) database.
Methods: We identified patients who underwent ACCF through CPT code 63081. Patients were stratified by frailty status using the modified 5-item frailty index (mFI-5) into not frail (score 0), pre-frail (score 1), and frail (score ≥2) groups. Cox proportional hazards models were employed to analyze time to complication, reoperation, and readmission. Linear regression was utilized for LOS analysis (extended LOS was above 75th percentile), while logistic regression was applied for non-routine discharge. All regression models were adjusted for injury year, age, BMI, smoking status, sex, race, ASA classification, and inpatient/outpatient status.
Results: The study cohort included 3,168 patients with a mean age of 57.83 years, 44.7% were obese, 18.5% were smokers, and predominantly white (75.3%) with a slight male predominance (54.2%). ASA classification was distributed as follows: 2.8% class 1, 37.8% class 2, 54.0% class 3, and 5.4% class 4 and above. Frail patients had increased odds of non-routine discharge (OR: 1.63; 95% CI, 1.19 to 2.24; P < .01), extended LOS (OR: 1.42; 95% CI, 1.06 to 1.90; P < .05), but no significantly different odds of readmission (OR: 0.66; 95% CI, 0.42 to 1.04; P =0.38) and reoperation (OR: 0.66; 95% CI, 0.40 to 1.10; P =0.06). Additionally, frail patients had shorter time to any complication (HR: 1.92; 95% CI, 1.39 to 2.66; P < .001) and serious complications (HR: 1.95; 95% CI, 1.41 to 2.70; P < .001).
Conclusion : The mFI-5 is associated with postoperative complications in ACCF procedures. This tool may aid in preoperative risk stratification, discharge planning, and patient counseling. Prospective studies are warranted to validate these findings and establish clinical guidelines for frailty assessment in ACCF patients.