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Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery.
J Neurosurg Spine. 2016 Oct; 25(4):537-541.JN

Abstract

OBJECTIVE

Limited tools exist to stratify perioperative risk in patients undergoing spinal procedures. The modified frailty index (mFI) based on the Canadian Study of Health and Aging Frailty Index (CSHA-FI), constructed from standard demographic variables, has been applied to various other surgical populations for risk stratification. The authors hypothesized that it would be predictive of postoperative morbidity and mortality in patients undergoing spine surgery.

METHODS

The 2006-2010 National Surgical Quality Improvement Program (NSQIP) data set was accessed for patients undergoing spine surgeries based on Current Procedural Terminology (CPT) codes. Sixteen preoperative clinical NSQIP variables were matched to 11 CSHA-FI variables (changes in daily activities, gastrointestinal problems, respiratory problems, clouding or delirium, hypertension, coronary artery and peripheral vascular disease, congestive heart failure, and so on). The outcomes assessed were 30-day occurrences of adverse events. These were then summarized in groups: any infection, wound-related complication, Clavien IV complications (life-threatening, requiring ICU admission), and mortality.

RESULTS

A total of 18,294 patients were identified. In 8.1% of patients with an mFI of 0 there was at least one morbid complication, compared with 24.3% of patients with an mFI of ≥ 0.27 (p < 0.001). An mFI of 0 was associated with a mortality rate of 0.1%, compared with 2.3% for an mFI of ≥ 0.27 (p < 0.001). Patients with an mFI of 0 had a 1.7% rate of surgical site infections and a 0.8% rate of Clavien IV complications, whereas patients with an mFI of ≥ 0.27 had rates of 4.1% and 7.1% for surgical site infections and Clavien IV complications, respectively (p < 0.001 for both). Multivariate analysis showed that the preoperative mFI and American Society of Anesthesiologists classification of ≥ III had a significantly increased risk of leading to Clavien IV complications and death.

CONCLUSIONS

A higher mFI was associated with a higher risk of postoperative morbidity and mortality, providing an additional tool to improve perioperative risk stratification.

Authors+Show Affiliations

Department of Neurosurgery, Henry Ford Hospital.Department of Neurosurgery, Henry Ford Hospital.Neuroscience Institute and the Center for Health Policy and Health Services Research, Henry Ford Health System; and.Department of Surgery, Henry Ford Hospital, Detroit, Michigan.Department of Surgery, Henry Ford Hospital, Detroit, Michigan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27153143

Citation

Ali, Rushna, et al. "Use of the Modified Frailty Index to Predict 30-day Morbidity and Mortality From Spine Surgery." Journal of Neurosurgery. Spine, vol. 25, no. 4, 2016, pp. 537-541.
Ali R, Schwalb JM, Nerenz DR, et al. Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J Neurosurg Spine. 2016;25(4):537-541.
Ali, R., Schwalb, J. M., Nerenz, D. R., Antoine, H. J., & Rubinfeld, I. (2016). Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. Journal of Neurosurgery. Spine, 25(4), 537-541.
Ali R, et al. Use of the Modified Frailty Index to Predict 30-day Morbidity and Mortality From Spine Surgery. J Neurosurg Spine. 2016;25(4):537-541. PubMed PMID: 27153143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. AU - Ali,Rushna, AU - Schwalb,Jason M, AU - Nerenz,David R, AU - Antoine,Heath J, AU - Rubinfeld,Ilan, Y1 - 2016/05/06/ PY - 2016/5/7/pubmed PY - 2017/2/14/medline PY - 2016/5/7/entrez KW - ACS NSQIP = American College of Surgeons National Surgical Quality Improvement Program KW - ASA = American Society of Anesthesiologists KW - CPT = Current Procedural Terminology KW - CSHA-FI = Canadian Study of Health and Aging Frailty Index KW - Canadian Study of Health and Aging Frailty Index KW - Clavien IV complications KW - National Surgical Quality Improvement Program KW - mFI = modified frailty index KW - modified frailty index KW - risk stratification SP - 537 EP - 541 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 25 IS - 4 N2 - OBJECTIVE Limited tools exist to stratify perioperative risk in patients undergoing spinal procedures. The modified frailty index (mFI) based on the Canadian Study of Health and Aging Frailty Index (CSHA-FI), constructed from standard demographic variables, has been applied to various other surgical populations for risk stratification. The authors hypothesized that it would be predictive of postoperative morbidity and mortality in patients undergoing spine surgery. METHODS The 2006-2010 National Surgical Quality Improvement Program (NSQIP) data set was accessed for patients undergoing spine surgeries based on Current Procedural Terminology (CPT) codes. Sixteen preoperative clinical NSQIP variables were matched to 11 CSHA-FI variables (changes in daily activities, gastrointestinal problems, respiratory problems, clouding or delirium, hypertension, coronary artery and peripheral vascular disease, congestive heart failure, and so on). The outcomes assessed were 30-day occurrences of adverse events. These were then summarized in groups: any infection, wound-related complication, Clavien IV complications (life-threatening, requiring ICU admission), and mortality. RESULTS A total of 18,294 patients were identified. In 8.1% of patients with an mFI of 0 there was at least one morbid complication, compared with 24.3% of patients with an mFI of ≥ 0.27 (p < 0.001). An mFI of 0 was associated with a mortality rate of 0.1%, compared with 2.3% for an mFI of ≥ 0.27 (p < 0.001). Patients with an mFI of 0 had a 1.7% rate of surgical site infections and a 0.8% rate of Clavien IV complications, whereas patients with an mFI of ≥ 0.27 had rates of 4.1% and 7.1% for surgical site infections and Clavien IV complications, respectively (p < 0.001 for both). Multivariate analysis showed that the preoperative mFI and American Society of Anesthesiologists classification of ≥ III had a significantly increased risk of leading to Clavien IV complications and death. CONCLUSIONS A higher mFI was associated with a higher risk of postoperative morbidity and mortality, providing an additional tool to improve perioperative risk stratification. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/27153143/Use_of_the_modified_frailty_index_to_predict_30_day_morbidity_and_mortality_from_spine_surgery_ L2 - https://thejns.org/doi/10.3171/2015.10.SPINE14582 DB - PRIME DP - Unbound Medicine ER -