Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery

Kevin Phan, Jun S. Kim, Nathan J. Lee, Sulaiman Somani, John Di Capua, Parth Kothari, Dante Leven, Samuel K. Cho*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

57 Citations (Scopus)


Background Context: Prior studies have suggested no significant differences in functional status and postoperative complications of elderly versus nonelderly patients undergoing posterior lumbar interbody fusion; however, similar studies have not been comprehensively investigated in the setting of anterior lumbar interbody fusion (ALIF). Purpose: The objective was to quantify the ability of the modified Frailty Index (mFI) to predict postoperative events in patients undergoing ALIF. Study Design: Secondary analysis of prospectively collected data. Patient Sample: Patients undergoing ALIF in the National Surgical Quality Improvement Program (NSQIP) participant files for the period 2010 through 2014. Outcomes Measures: Outcome measures included any postoperative complication, return to operating room (OR), and length of stay >5 days. Methods: NSQIP participant files from 2010 to 2014 were used to identify patients undergoing ALIF. The mFI used in the present study is an 11-variable assessment that maps 16 NSQIP variables to 11 variables in the Canadian Study of Health and Ageing Frailty Index. Univariate analysis and multivariable logistic regression models were used to compare the relative strength of association between mFI with outcome variables of interest. Results: In total, 3,920 ALIF cases were identified and grouped according to their mFI score: 0 (n=2,025), 0.09 (n=1,382), 0.18 (n=464), or ≥0.27 (n=49). As the mFI increased from 0 (no frailty-associated variables) to 0.27 (4 of 11) or higher, there was a significant stepwise increase in any complication from 10.8% to 32.7%. After multivariable regression analysis, no significant association was found between higher mFI scores with urinary tract infections and venous thromboembolism. High frailty scores were significant predictors of any complication (mFI of ≥0.27 [reference: 0]; OR 2.4; p=.040) and pulmonary complications (mFI score ≥0.27; OR 7.5; p=.001). Conclusions: In summary, high mFI scores were found to be independently associated with any complication and pulmonary complications in patients who underwent ALIF. The use of mFI together with traditional risk factors may help better identify high-surgical risk patients, which may be useful for preoperative and postoperative care optimization.

Original languageEnglish
Pages (from-to)538-544
Number of pages7
JournalSpine Journal
Issue number4
Publication statusPublished - Apr 2017
Externally publishedYes


  • American College of Surgeons National Surgical Quality Improvement Program
  • anterior lumbar interbody fusion
  • frailty index
  • morbidity
  • mortality
  • short term


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