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The preoperative risk stratification of patients undergoing spinal tumor resection remains challenging. In recent years, the efforts to look beyond age alone as an outcomes predictor has resulted in the development of measures of physiological reserve (or ‘frailty indices’). The most frequently cited index in spine surgery is the modified frailty index [11-point (mFI-11) or 5-point (mFI-5)]. The present study was performed to evaluate effect of frailty (as measured by mFI-5) versus age on surgical outcomes of spinal tumors in a large national registry.


The National Surgical Quality Improvement Program (NSQIP) database was used to collect data for patients undergoing spinal tumor resection from 2015 to 2019 (n = 4662). Univariate analysis for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a non-home destination. Multivariable modeling of age and mFI-5, controlling for co- variates, was done to define the discriminative ability of each measure. Effect sizes were summarized by odds ratio (OR) (dichotomous outcomes) or beta coefficients (continuous outcomes) and associated 95% confidence intervals (95% CI).


Univariate analysis demonstrated that mFI-5 but not age was significantly predictive of 30-day mortality, major complication, unplanned readmission, unplanned reoperation, hospital LOS, and discharge to non-home destination. This was confirmed by the multivariable regression analysis. Based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of all adverse outcomes, with ‘Severely Frail’ patients demonstrating an effect size of 16 times larger for 30-day mortality and 3 times larger for major complication and hospital LOS.


Increasing frailty, as measured by mFI-5, and not increasing age, is an independent risk factor for poor surgical outcomes in spinal tumors patients. The mFI-5 may be used for pre-operative risk stratification of these patients.


Poster presented at the Brain & Behavioral Health Research Day 2021



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