Can Frailty Predict 90-Day Postoperative Outcome in Elderly Patients with Degenerative Cervical Spine Pathology?

Age and general health status are major points of concern in the decision-making process when it comes to cervical spine surgeries in the elderly. While there have been studies on the various frailty indices in their ability to predict outcomes in spine surgery, there have been few articles that have investigated the utility of the 5-point modified Frailty Index (mFI-5) for this purpose. Our study attempts to have a granular view of the problem of frailty in the elderly and study the correlation between the mFI-5 and American society of anesthesiologists (ASA) classes, and the 90-day surgical outcome of patients of 60 years and above, operated for degenerative cervical spine pathologies. This is a single-center retrospective study of prospectively collected data on 41 patients aged 60 years and above who were operated at our institute between January 1, 2017, and December 31, 2022. We studied the correlation of mFI-5, ASA class and the Spinal Surgical Invasiveness Index (SII) with various outcome variables like length of hospital stay, need for ICU stay, complications, severe adverse events (Clavien Dindo grade 4 and above), re-intubation, unplanned re-admission, and need for re-operation. Statistical analysis showed a significant correlation between ASA class and mFI-5 scores (Chi square test, P value: 0.0401) and between ASA scores and the need for an ICU stay (Chi square test, P value: 0.0047). SII was found to correlate with length of hospital stay (Spearman rank test, P value: 0.0037) and with need for ICU care (Mann–Whitney U test, P value 0.0422). However, there was no significant correlation between the mFI-5 scores and the outcome variables. Although there was no significant correlation between mFI-5 and the 90-day surgical outcome, variables like ASA and SII had a bearing on it. Thus, it can be stated that the outcome of cervical spine surgery in the elderly is multifactorial. While frailty should put the healthcare team on alert while dealing with such patients, it should not discourage them from offering a surgical solution when required, as efficient peri-operative management by the surgical, anesthesia, and critical care teams can lead to favorable 90-day outcomes.