Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion surgery (ALIF)

Abstract Background Context Prior studies have suggested no significant differences in functional status and postoperative complications of elderly versus non-elderly patients undergoing posterior lumbar interbody fusion; however, similar studies have not been comprehensively investigated in the setting of anterior lumbar interbody fusion (ALIF). Purpose The objective was to quantify the ability of the modified Frailty Index (mFI) to predict postoperative events in patients undergoing ALIF. Study Design Secondary analysis of prospectively collected data Patient Sample Patients undergoing ALIF in the National Surgical Quality Improvement Program (NSQIP) participant files for the period 2010 through 2014. Outcomes Measures Outcomes measures included any postoperative complication, return to operating room (OR), and length of stay (LOS) > 5 days. Methods NSQIP participant files 2010 – 2014 were used to identify patients undergoing ALIF. mFI used in the present study is an 11-variable assessment that map 16 NSQIP variables to 11 variables in the Canadian Study of Health and Ageing Frailty Index (CSHA-FI). Univariate analysis and multivariable logistic regression models were used to compare the relative strength of association between mFI with outcome variables of interest. Results In total, 3,920 ALIF cases were identified and grouped according to their mFI score: 0 (n=2,025), 0.09 (n=1,382), 0.18 (n=464), or ≥0.27 (n=49). As the mFI increased from 0 (no frailty associated variables) to 0.27 (4 of 11) or higher, there was a significant stepwise increase in any complication from 10.8% to 32.7%. After multivariable regression analysis, no significant association was found between higher mFI scores with urinary tract infections and venous thromboembolism. High frailty scores were significant predictors of any complication (mFI of ≥ 0.27 (reference: 0); OR 2.4; P=0.040) and pulmonary complications (mFI score ≥0.27; OR 7.5; P=0.001). Conclusion In summary, high mFI scores were found to be independently associated with any complication and pulmonary complications in patients who underwent ALIF. The use of mFI together with traditional risk factors may help better identify high-surgical risk patients, which may be useful for preoperative and postoperative care optimization.