The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies.

Milena Fini,Francesca Veronesi,Veronica Borsari,Andrea Visani,Lucia Martini,Giovanni Barbanti Brodano,Alessandro Gasbarrini

doi:10.14336/ad.2020.0904

Abstract

Frailty is a condition characterized by a high vulnerability to low-power stressor. Frailty increases with age and is associated with higher complications and mortality. Several indexes have been used to quantify frailty. Spine diseases, both degenerative and oncologic, frequently require surgery which is related to complications and mortality. Aim of the present systematic review was to collect the most frequently used frailty indexes in clinics to predict surgical outcomes in patients affected by spine diseases, taking into account gender differences. Three databases were employed, and 29 retrospective clinical studies were included in this systematic review. The identified spine pathologies were primary and metastatic spine tumors, adult spine deformity (ASD), degenerative spine disease (DSD), cervical deformity (CD) and other pathologies that affected lumbar spine or multiple spine levels. Eleven indexes were identified: modified Frailty Index (mFI), Adult spinal deformity frailty index (ASD-FI), mFI-5, Metastatic Spinal Tumor Frailty Index (MSTFI), Fried criteria, Cervical deformity frailty index (CD-FI), Spinal tumor frailty index (STFI), Frailty Phenotype criteria (FP), Frailty Index (FI), FRAIL scale and Modified CD-FI (mCD-FI). All these indexes correlated well with minor and major postoperative complications, mortality and length of stay in hospital. Results on gender differences and frailty are still conflicting, although few studies show that women are more likely to develop frailty and more complications in the post-operative period than men. This systematic review could help the surgeon in the adoption of frailty indexes, before the operation, and in preventing complications in frail patients.

Highlights

Even if frailty condition has been known for more than 30 years, the definition of the frail phenotype was first given in geriatric literature by Fried in 2001 [1] and has gained wide attention only in the last years
[51], 2006-2010 [52] or 2006-2015 [53] years, a multicenter, prospective database maintained by the International Spine Study Group (ISSG) or European Spine Study Group (ESSG) database in 2010-2014 years [34,35,36, 43], Spine Surgery Database of Adverse Events in 2009-2013 years [40], a multicenter database of 13 spine surgery centers across the USA in 2013-2018 years [44, 45], Spinal center of a tertiary-care teaching hospital database in 2014-2017 years [50, 56], Mount Sinai Electronic Scheduling system in 2013-2014 years [54] and not defined hospital database in which the research was carried in 2010-2015 [30], 2009-2016 [31], 20052015 [42], 2010-2013 [55], not specified [33, 37, 38] years
Metastatic Spinal Tumor Frailty Index (MSTFI) was compared with modified Frailty Index (mFI), underling that mFI correlated with complications, while MSTFI with mortality [31]

Summary

Introduction

Even if frailty condition has been known for more than 30 years, the definition of the frail phenotype was first given in geriatric literature by Fried in 2001 [1] and has gained wide attention only in the last years. A consensus conference in December of 2012, led by the International Association of Gerontology and Geriatrics and the World Health Organization, defined frailty as ‘‘a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death’’[2]. With increase in life expectancy, chronic noncommunicable diseases have become prevalent together with a rising number of elderly patients affected by degenerative, traumatic, oncologic or infective pathologies. These demographic and epidemiologic transitions have a deep impact on health care provision and economic burden. In a prospective cohort study from US, pre-frailty and frailty are associated with higher subsequent total healthcare costs in older community-dwelling men [12]

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