• WilsonJamie R FJRF0000-0002-3488-7506Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198, USA.Spine Program, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada.Division of Neurosurgery, Krembil Neuroscien, Jetan H Badhiwala, Ali Moghaddamjou, Albert Yee, Jefferson R Wilson, and Michael G Fehlings.
• Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE 68198, USA.
• J Clin Med. 2020 Oct 29; 9 (11).

BackgroundThe ability of frailty compared to age alone to predict adverse events in the surgical management of Degenerative Cervical Myelopathy (DCM) has not been defined in the literature.Methods41,369 patients with a diagnosis of DCM undergoing surgery were collected from the National Surgical Quality Improvement Program (NSQIP) Database 2010-2018. Univariate analysis for each measure of frailty (modified frailty index 11- and 5-point; MFI-11, MFI-5), modified Charlson Co-morbidity index and ASA grade) were calculated for the following outcomes: mortality, major complication, unplanned reoperation, unplanned readmission, length of hospital stay, and discharge to a non-home destination. Multivariable modeling of age and frailty with a base model was performed to define the discriminative ability of each measure.ResultsAge and frailty have a significant effect on all outcomes, but the MFI-5 has the largest effect size. Increasing frailty correlated significantly with the risk of perioperative adverse events, longer hospital stay, and risk of a non-home discharge destination. Multivariable modeling incorporating MFI-5 with age and the base model had a robust predictive value (0.85). MFI-5 had a high categorical assessment correlation with a MFI-11 of 0.988 (p < 0.001).Conclusions And RelevanceMeasures of frailty have a greater effect size and a higher discriminative value to predict adverse events than age alone. MFI-5 categorical assessment is essentially equivalent to the MFI-11 score for DCM patients. A multivariable model using MFI-5 provides an accurate predictive tool that has important clinical applications.

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