Frailty adversely affects outcomes of patients undergoing spine surgery: a systematic review

With an aging population, there are an increasing number of elderly patients undergoing spine surgery. Recent literature in other surgical specialties suggest frailty to be an important predictor of outcomes. The aim of this review was to examine the association between frailty and outcomes after spine surgery. A systematic review was performed. Electronic databases from 1946 to 2020 were searched to identify articles on frailty and spine surgery. The primary outcome was adverse events. Secondary outcomes included other measures of morbidity, mortality, and patient outcomes. Sample size, mean age, age limitation, data source, study design, primary pathology, surgical procedure performed, follow-up period, assessment of frailty used, surgical outcomes, and impact of frailty on outcomes were extracted from eligible studies. Quality and bias were assessed using the PRISMA 27-point item checklist and the QUADAS-2 tool. Thirty-two studies were selected for review, with a total of 127,813 patients. There were eight different frailty indices/measures. Regardless of how frailty was measured, frailty was associated with an increased risk of adverse events, mortality, extended length of stay, readmission, and nonhome discharge. There is strong evidence that frailty is associated with an increased risk of morbidity and mortality in patients who received spine surgery. However, it remains inconclusive whether frailty impacts patient outcomes and quality of life after surgery.