69 - Analysis of the individual comorbidities that compose the 5-item modified frailty index in spine surgery: should all factors be weighted equally?

Saturday, June 3, 2023

11:26 AM – 11:28 AM

Location: Salons 10-12

Co-Author(s)

GC

Gaston O. Camino-Willhuber, caminowillhuberg@hss.edu

Hospital for Special Surgery
Brooklyn, New York, United States

Co-Author(s)

HH

Henryk Haffer

Germany
ST

Soji Tani, MD, PhD

Spine Care Institute, Hospital for Special Surgery
New York, New York, United States
EC

Erika A. Chiapparelli, MD

Spine Research Fellow
Spine Care Institute, Hospital for Special Surgery
NYC, New York, United States
KA

Krizia Amoroso

United States
MM

Maximilian Muellner

Germany
MS

Michele Sarin

United States
JS

Jennifer Shue, MS

Spine Care Institute, Hospital for Special Surgery
New York, New York, United States
ES

Ellen M. Soffin, MD PhD

Attending Anesthesiologist
Hospital for Special Surgery, United States
WZ

William D. Zelenty, MD

Assistant Attending Surgeon
Spine Care Institute, Hospital for Special Surgery
New York, New York, United States
GS

Gbolabo Sokunbi, MD

Surgeon
Spine Care Institute, Hospital for Special Surgery
New York, New York, United States
DL

Darren R. Lebl, MD, MBA

Spine Surgeon
Spine Care Institute, Hospital for Special Surgery
New York, New York, United States
FC

Frank P. Cammisa, Jr, MD

Chief Emeritus
Spine Care Institute, Hospital for Special Surgery
New York, New York, United States
FG

Federico P. Girardi, MD

Surgeon
Spine Care Institute, Hospital for Special Surgery
New York, New York, United States
AH

Alexander P. Hughes, MD

Surgeon
Spine Care Institute, Hospital for Special Surgery
New York, New York, United States

Presenting Author (Person doing the Podium Present(s)

AS

Andrew A. Sama, MD

Co-Chief, Orthopaedic Spine Service
Spine Care Institute, Hospital for Special Surgery
New York, New York, United States

Submitter(s)

GC

Gaston O. Camino-Willhuber, caminowillhuberg@hss.edu

Hospital for Special Surgery
Brooklyn, New York, United States

Disclosure(s):

Soji Tani, MD, PhD: No financial relationships to disclose

Introduction
Preoperative risk stratification is essential to assess a patient’s risk of postoperative complications. Several indices such as the Canadian Study of Health and Aging Frailty Index (CSHA-FI), the modified 11-item index, and the recently modified 5-item frailty (mFI-5) index have been created to evaluate patient frailty and improve risk assessments. Based on the mFI-5 item, frailty is defined by the presence of two or more comorbidities, this score appears to be simple and effective in predicting complications in spine surgery, however, the individual components of this score might have different weights and therefore, heterogeneous impact on the occurrence of complications.
Objective
To analyze and determine the individual influence of the variables that compose the modified 5-item frailty index score (mFI-5) on complications, reoperation, readmission, and mortality after spine surgery.
Methods
The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent spine surgery from 2009- 2019. The mFI-5 score was calculated based on the following 5 comorbidities: 1) congestive heart failure within 30 days prior to surgery, 2) insulin-dependent or non-insulin-dependent diabetes, 3) chronic obstructive pulmonary disease or pneumonia, 4) partially dependent or totally dependent functional health status and 5) hypertension requiring medication. Multivariable analysis was used to assess the independent impact of each comorbidity in the mFI-5 score on the risk of complications.
Results
167,630 patients were included with a mean age of 59.9 ± 14.1 years. Complications were observed in 15,515 (9.3%). 3,020 patients had surgical complications (1.8%), 4,608 required reoperations (2.7%), 7,892 were readmitted (4.7%), and 383 died (0.2%) within 30 days after surgery. Multivariable analysis demonstrated that patients with presence of congestive heart failure and dependent functional health status had a significantly higher risk of complications (OR=2.422 and 2.499 respectively) compared to diabetes (OR=1.183), hypertension (OR=1.296), and chronic obstructive pulmonary disease (OR=1.363). Similar results were observed for reoperation, readmission and mortality.
Conclusion
The individual impact of each comorbidity that composes the frailty score is heterogeneous. Patients with congestive heart failure and dependent status have higher risk of complications compared with the rest of the comorbidities included in the score.