The modified frailty index and patient outcomes following transforaminal lumbar interbody fusion surgery for single-level degenerative spine disease

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  • 1 Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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OBJECTIVE

The modified frailty index (mFI) is a simple tool that measures physiological reserve based on a thorough history and physical examination. Its use has been validated in several surgical specialties, including spinal deformity surgery. Prior research has suggested no significant differences in clinical outcomes between elderly and nonelderly patients undergoing posterior lumbar interbody fusion. The authors sought to investigate the use of the mFI in patients undergoing transforaminal lumbar interbody fusion (TLIF) and the relationship between frailty scores and clinical outcomes.

METHODS

A retrospective chart review was conducted on 198 patients who underwent a single-level TLIF over a 60-month period at a single institution. For all patients, an mFI score was computed incorporating a set of 11 clinical factors to assess preexisting comorbidities and functional status. Clinical follow-up and health-related quality-of-life (HRQOL) scores were obtained at baseline and regular intervals of 6 weeks, 6 months, and 1 year following surgery.

RESULTS

Patients were grouped according to their level of frailty: no frailty (mFI = 0), mild frailty (mFI = 0.09), moderate frailty (mFI = 0.18), and severe frailty (mFI ≥ 0.27). One-way ANOVA revealed increasing levels of frailty to be associated with an increased rate of complications, from 10.3% to 63.6%. In addition, increasing levels of frailty were associated with longer hospital length of stay (LOS), from 3.1 days to 6.5 days, and lower rates of disposition to home. At the 1-year follow-up, increased levels of frailty were associated with worse HRQOL measures.

CONCLUSIONS

Increasing mFI score was associated with higher morbidity, longer inpatient LOS, and a lower probability of discharge to home in patients undergoing single-level TLIF. Consideration of the mFI may help surgeons improve decision-making across the spectrum of patients who are at risk from frailty.

ABBREVIATIONS

ALIF = anterior lumbar interbody fusion; COPD = chronic obstructive pulmonary disease; EBL = estimated blood loss; HRQOL = health-related quality of life; LOS = length of stay; MCID = minimum clinically important difference; MCS = SF-12 mental component summary; mFI = modified frailty index; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; OR = operating room; PCS = SF-12 physical component summary; PLF = posterior lateral fusion; SRS = Scoliosis Research Society; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale.

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Contributor Notes

Correspondence Richard G. Fessler: Rush University Medical Center, Chicago, IL. rfessler@rush.edu.

INCLUDE WHEN CITING Published online June 4, 2021; DOI: 10.3171/2020.11.SPINE201263.

Disclosures Dr. Fontes: consultant for Globus Medical. Dr. O’Toole: ownership in Theracell; consultant for Globus Medical; and royalties from Globus Medical and RTI Surgical.

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