Modified Frailty Index Questionnaire as a Predictor of Discharge Destination in Elderly Patients Undergoing Multilevel Lumbar Interbody Fusion.

Abstract

Frailty is defined as a state in which depletion of physiologic reserves causes multisystem impairments independent of natural senescence. This phenomenon can be quantified by the 11-point modified frailty index (mFI-11). This study determines whether an 11-point patient questionnaire developed from the mFI-11 can be used as a predictor for discharge destination following multilevel lumbar interbody fusion surgery in elderly patients. This retrospective chart review identified all patients aged 60 years or more who underwent multilevel lumbar interbody fusion at a single tertiary care center. Frailty scores and discharge destinations were recorded. T-testing, analysis of variance, and linear correlative models were performed to test for significance. A total of 213 patients were included in the study with an average frailty score of 2.26. Frailty score was higher in patients who were discharged with home health (P < 0.001), to inpatient rehabilitation (P < 0.001), and to a skilled nursing facility (P < 0.001) than in patients routinely discharged home. Patients with a routine discharge had lower frailty scores than those without a routine discharge to their home (P < 0.001). Increased frailty was significantly associated with nonhome discharge, discharge to home health, rehabilitation, or skilled nursing facility. This is likely due to the impact which comorbidities represented by the frailty questionnaire and mFI-11 have on patient healing and postoperative recovery. Frailty score may be incorporated into the informed consent process and shared decision-making between patients and their surgeons to better predict the likelihood of discharge home.