Frailty Predicts Discharge to Non-home and Advanced Care Facilities in Patients Undergoing Surgery for Lumbar Spinal Degenerative Disease: A NSQIP Analysis of 7392 Patient Cases

Introduction: While spinal fixation for degenerative spine disease is generally considered to be low risk, preoperative risk stratification to optimally reduce poor outcomes is paramount. The present study sought to establish the relationship of frailty, as measured by the 5-factor Modified Frailty Index (mFI-5) and Risk Analysis Index (RAI-rev), on discharge to any non-home destination (NHD) and discharge to advanced care facilities (FD).

Methods: The ACS-NSQIP (2012-2020) was queried for any adult (≥18 years) who underwent surgical intervention for degenerative lumbar spine disease using procedural and diagnostic codes. Descriptive statistics and univariate crosstabulation were used to describe baseline demographics, preoperative comorbidities, and postoperative outcomes for the study cohort and to compare these factors between the NHD and FD subgroups. Receiver operator characteristic (ROC) curve analysis was used to assess the discriminative ability of the mFI-5 and RAI on NHD and FD.

Results: Our final cohort (N=7392) had a median age of 56 years and was 50.2% female. NHD and FD occurred in 13.5% and 7.6% of cases, respectively. ROC curve analysis demonstrated that both mFI-5 and RAI predict NHD (C-statistics: RAI: 0.736; mFI-5 0.644) and FD (C-statistics: RAI: 0.748; mFI-5: 0.630) with notable accuracy. DeLongs test demonstrated that RAI was significantly better than mFI-5 at predicting both of these primary outcomes in the present study cohort (P < 0.0001).

Conclusion : Preoperative risk stratification is key in reduction of poor outcomes. The present analysis demonstrated that frailty, as measured by mFI-5 and RAI, is a reliable predictor of two major poor outcomes: non-home discharge and discharge to an advanced care facility. Identification of high-risk patients is a critical step prior to surgery. The author’s hope these findings contribute to clinical knowledge and serve as a foundation for future research with the goal of optimizing spinal surgery outcomes.