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.Links
MeSH
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 -