Asian Spine J.  2019 Oct;13(5):861-873. 10.31616/asj.2018.0239.

Frailty Syndrome and the Use of Frailty Indices as a Preoperative Risk Stratification Tool in Spine Surgery: A Review

• Simcox T
• Antoku D
• Jain N
• Acosta F
• Hah R

• KMID: 2462017
• DOI: http://doi.org/10.31616/asj.2018.0239

Abstract

This comprehensive narrative literature review aims to extract studies related to frailty indices and their use in elective spine procedures, as limited studies regarding frailty exist in the spine literature. Most studies are retrospective analyses of prospectively collected databases. Evidence suggests a positive correlation between frailty level and mortality rate, postoperative complication rate, length of stay, and the possibility of discharge to a skilled nursing facility; these correlations have been illustrated across various spine procedures. The leading index is the modified frailty index, which measures 11 deficits. The development of more comprehensive frailty indices, such as the Adult Spinal Deformity Frailty Index, are promising and have high predictive value regarding postoperative complication rate in patients with spinal deformity. However, a frailty index that combines clinical, radiographic, and laboratory measures awaits development. Perhaps, the use of a frailty index in preoperative risk stratification for elective spine procedures could serve multiple purposes, including screening for high-risk patients, enhancement of operative decision making, approximation of complication rate for informed decision making, and refinement of perioperative care. Further prospective studies are warranted to determine clinically meaningful interventions in frail individuals.

Keyword

Frailty; Adverse events; Elective surgical procedure; Spine; Mortality

MeSH Terms

Adult
Congenital Abnormalities
Decision Making
Elective Surgical Procedures
Humans
Length of Stay
Mass Screening
Mortality
Perioperative Care
Postoperative Complications
Prospective Studies
Retrospective Studies
Skilled Nursing Facilities
Spine*