• Gaston Camino-Willhuber, Henryk Haffer, Maximilian Muellner, Yusuke Dodo, Erika Chiapparelli, Soji Tani, Krizia Amoroso, Michele Sarin, Jennifer Shue, Ellen M Soffin, William D Zelenty, Gbolabo Sokunbi, Darren R Lebl, Frank P Cammisa, Federico P Girardi, Alexander P Hughes, and Andrew A Sama.
• Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York, USA.
• World Neurosurg. 2023 Jun 12.

BackgroundFrailty status has been associated with higher rates of complications after spine surgery. However, frailty patients constitute a heterogeneous group based on the combinations of comorbidities. The objective of this study is to compare the combinations of variables that compose the modified 5-factor frailty index score (mFI-5) based on the number of comorbidities in terms of complications, reoperation, readmission, and mortality after spine surgery.MethodsThe American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Database from 2009-2019 was used to identify patients who underwent elective spine surgery. The mFI-5 item score was calculated and patients were classified according to number and combination of comorbidities. Multivariable analysis was used to assess the independent impact of each combination of comorbidities in the mFI-5 score on the risk of complications.ResultsA total of 167, 630 patients were included with a mean age of 59.9 ± 13.6 years. The risk of complications was the lowest in patients with diabetes + hypertension (OR = 1.2) and highest in those with the combination of congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disease (COPD), and dependent status (OR = 6.6); there was a high variation in complication rate based on specific combinations.ConclusionsThere is high variability in terms of relative risk of complications based on the number and combination of different comorbidities, especially with CHF and dependent status. Therefore, frailty status encompasses a heterogeneous group and sub-stratification of frailty status is necessary to identify patients with significantly higher risk of complications.Copyright © 2023 Elsevier Inc. All rights reserved.

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