A High Frailty Burden is a Strong Predictor of Adverse Postoperative Outcomes in Geriatric Lumbar Spine Surgery: A Retrospective Cohort Study.

Abstract

Study DesignRetrospective cohort study.ObjectivesTo determine whether the 5-item modified frailty index (mFI-5) is associated with in-hospital complications and 1-year adverse events among patients aged ≥70 years who underwent lumbar spine surgery.MethodsWe retrospectively reviewed data from patients aged ≥70 years who underwent lumbar spine surgery at a single tertiary referral hospital from January 2020 to December 2021, with 1-year follow-up. Participants were stratified into two groups based on an mFI-5 score of 3. The primary outcome was the odds of in-hospital complications, and the secondary outcome was the odds of 1-year adverse events. To account for confounding variables and identify independent predictors, we applied inverse probability of treatment weighting (IPTW) and multivariable logistic regression.ResultsAmong 967 eligible older adults, 132 (13.6%) met the criteria for severe frailty (mFI-5 score ≥3). Following IPTW adjustment, severe frailty was significantly and independently associated with in-hospital complications (odds ratio: 1.792, 95% confidence interval: 1.243-2.585; <i>P</i> = 0.002). Higher American Society of Anesthesiologists Physical Status scores, functional dependence, and in-hospital complications were strong predictors of 1-year adverse events.ConclusionSevere frailty was independently associated with in-hospital complications in older adults undergoing lumbar spine surgery. The mFI-5 may serve as a practical tool for stratifying preoperative surgical risk and tailoring perioperative management.