Modifiable Uncontrolled Frailty (mFI-5) in Lumbar Fusion Outcomes.
Publication/Presentation Date
2-11-2026
Abstract
STUDY DESIGN: Retrospective Cohort.
OBJECTIVE: To investigate impact of controlled/uncontrolled sub-stratification of modified frailty index (MFI-5) on postoperative outcomes after lumbar fusion for degenerative disease.
BACKGROUND: mFI-5 outperforms age as a predictor of postoperative risk. Sub-stratification of mFI-5 by controlled versus uncontrolled frailty has allowed for better risk prognostication in spinal deformity cases.
METHODS: Adult patients who underwent elective, single-level lumbar fusion (2017-2021) were identified. Fusions for infection/trauma/tumor/revision were excluded. Patients were classified as frail/non-frail based on having any mFI-5 criteria (history of chronic obstructive pulmonary disease [COPD], congestive heart failure [CHF], diabetes mellitus [DM], hypertension [HTN] requiring medication, and functional status). Frailty was considered controlled unless patients had a COPD exacerbation within 3 months prior to surgery, preoperative hemoglobin A1c >7, or HTN ≥140/90 mmHg for ≥2 visits.
RESULTS: 1,286 patients were included (controlled/uncontrolled/non-frail-804/159/323). Uncontrolled frailty patients had more 31-90 day ED visits (9.43% vs. 4.13%,P=0.009), 0-30 day readmissions (5.66% vs. 2.49%,P=0.042), and renal complications (13.2% vs. 6.38%,P=0.005) compared to controlled frailty patients. Controlled frailty patients were older (56.3 vs. 62.9, P< 0.001) and had more 0-30 day ED visits (2.19% vs. 5.63%,P=0.021) compared to non-frail patients. Uncontrolled frailty patients were older (56.3 vs. 63.8,P< 0.001), and had higher 0-30 (2.19% vs. 7.55%,P=0.010) and 31-90 day ED visits (1.88% vs. 9.43%,P< 0.001), 0-30 day readmissions (0.93% vs. 5.66%,P=0.003), and renal complications (3.76% vs. 13.2%,P< 0.001) compared to non-frail patients. Multivariable regression demonstrated that uncontrolled frailty alone was independently associated with 30-day ED visits (odds ratio [OR]-3.68,P=0.030), any ED visit (OR-3.33,P=0.008), 90-day readmission (OR-5.42,P=0.047) and any readmission (OR-5.41,P=0.005).
CONCLUSION: Multivariable regression demonstrated that uncontrolled frailty was an independent risk factor for ED visits and readmission after single-level lumbar fusion. Further work is needed to identify the best pre- and postoperative strategies to optimize outcomes for this vulnerable population.
ISSN
1528-1159
Published In/Presented At
Olson, J., Dalton, J., Baek, G., Green, W. A., Baidya, J., Oris, R. J., Huang, R., Herczeg, C., Ng, M., Lee, Y., Mathew, J., Chua, T., Witt, L., Czaernecki, J., Fuleihan, A., Canseco, J., Hilibrand, A., Vaccaro, A., Schroeder, G., & Kepler, C. (2026). Modifiable Uncontrolled Frailty (mFI-5) in Lumbar Fusion Outcomes. Spine, 10.1097/BRS.0000000000005661. Advance online publication. https://doi.org/10.1097/BRS.0000000000005661
Disciplines
Medicine and Health Sciences
PubMedID
41701607
Department(s)
Medical Education
Document Type
Article