Study Design. Retrospective Cohort Objective. To investigate impact of controlled/uncontrolled sub-stratification of modified frailty index (MFI-5) on postoperative outcomes after lumbar fusion for degenerative disease. Background. mFI-5 outperforms age as a predictor of postoperative risk. Sub-stratification of mFI-5 by controlled versus uncontrolled frailty has allowed for better risk prognostication in spinal deformity cases. Methods. Adult patients who underwent elective, single-level lumbar fusion (2017-2021) were identified. Fusions for infection/trauma/tumor/revision were excluded. Patients were classified as frail/non-frail based on having any mFI-5 criteria (history of chronic obstructive pulmonary disease COPD, congestive heart failure CHF, diabetes mellitus DM, hypertension HTN requiring medication, and functional status). Frailty was considered controlled unless patients had a COPD exacerbation within 3 months prior to surgery, preoperative hemoglobin A1c >7, or HTN ≥140/90 mmHg for ≥2 visits. Results. 1,286 patients were included (controlled/uncontrolled/non-frail—804/159/323). Uncontrolled frailty patients had more 31-90 day ED visits (9.43% vs. 4.13%, P =0.009), 0-30 day readmissions (5.66% vs. 2.49%, P =0.042), and renal complications (13.2% vs. 6.38%, P =0.005) compared to controlled frailty patients. Controlled frailty patients were older (56.3 vs. 62.9, P <0.001) and had more 0-30 day ED visits (2.19% vs. 5.63%, P =0.021) compared to non-frail patients. Uncontrolled frailty patients were older (56.3 vs. 63.8, P <0.001), and had higher 0-30 (2.19% vs. 7.55%, P =0.010) and 31-90 day ED visits (1.88% vs. 9.43%, P <0.001), 0-30 day readmissions (0.93% vs. 5.66%, P =0.003), and renal complications (3.76% vs. 13.2%, P <0.001) compared to non-frail patients. Multivariable regression demonstrated that uncontrolled frailty alone was independently associated with 30-day ED visits (odds ratio OR—3.68, P =0.030), any ED visit (OR—3.33, P =0.008), 90-day readmission (OR—5.42, P =0.047) and any readmission (OR—5.41, P =0.005). Conclusion. Multivariable regression demonstrated that uncontrolled frailty was an independent risk factor for ED visits and readmission after single-level lumbar fusion. Further work is needed to identify the best pre- and postoperative strategies to optimize outcomes for this vulnerable population.
Olson et al. (Wed,) studied this question.