PMID- 34010683 OWN - NLM STAT- MEDLINE DCOM- 20220106 LR - 20220106 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 21 IP - 11 DP - 2021 Nov TI - Modified-frailty index does not independently predict complications, hospital length of stay or 30-day readmission rates following posterior lumbar decompression and fusion for spondylolisthesis. PG - 1812-1821 LID - S1529-9430(21)00242-4 [pii] LID - 10.1016/j.spinee.2021.05.011 [doi] AB - BACKGROUND CONTEXT: Frailty has been associated with inferior surgical outcomes in various fields of spinal surgery. With increasing healthcare costs, hospital length of stay (LOS) and unplanned readmissions have emerged as clinical proxies reflecting overall value of care. However, there is a paucity of data assessing the impact that baseline frailty has on quality of care in patients with spondylolisthesis. PURPOSE: The aim of this study was to investigate the impact that frailty has on LOS, complication rate, and unplanned readmission after posterior lumbar spinal fusion for spondylolisthesis. STUDY DESIGN: A retrospective cohort study was performed using the National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2016. PATIENT SAMPLE: All adult (>/=18 years old) patients who underwent lumbar spinal decompression and fusion for spondylolisthesis were identified using ICD-9-CM diagnosis and procedural coding systems. We calculated the modified frailty index (mFI) for each patient using 5 dichotomous comorbidities - diabetes mellitus, congestive heart failure, hypertension requiring medication, chronic obstructive pulmonary disease, and dependent functional status. Each comorbidity is assigned 1 point and the points are summed to give a score between 0 and 5. As in previous literature, we defined a score of 0 as "not frail", 1 as "mild" frailty, and 2 or greater as "moderate to severe" frailty. OUTCOME MEASURES: Patient demographics, comorbidities, complications, LOS, readmission, and reoperation were assessed. METHODS: A multivariate logistic regression analysis was used to identify independent predictors of adverse events (AEs), extended LOS, complications, and unplanned readmission. RESULTS: There were a total of 5,296 patients identified, of which 2,030 (38.3%) were mFI=0, 2,319 (43.8%) patients mFI=1, and 947 (17.9%) were mFI >/=2. The mFI>/=2 cohort was older (p/=2 cohort had a slightly longer hospital stay (3.7 +/- 2.3 days vs. mFI=1: 3.5 +/- 2.8 days and mFI=0: 3.2 +/- 2.1 days,p/=2 cohort than the other cohorts, (2.6% vs. mFI=1: 1.8% and mFI=0: 1.2%,p=.022) and (6.3% vs. mFI=1: 4.8% and mFI=0: 2.6%,p/=2 cohort had greater unplanned 30-day readmission rates (8;4% vs. mFI=5.6: 4.8% and mFI=0: 3.4%,p/=2 was not a significant independent predictor of LOS (p=.285), complications (p=.667), or 30-day unplanned readmission (p=.378). CONCLUSIONS: Our study indicates that frailty, as measured by the mFI, does not significantly predict LOS, 30-day adverse events, or 30-day unplanned readmission in patients undergoing lumbar spinal decompression and fusion for spondylolisthesis. Further work is needed to better define variable inputs that make up frailty to optimize surgical outcome prediction tools that impact the value of care. CI - Copyright (c) 2021. Published by Elsevier Inc. FAU - Elsamadicy, Aladine A AU - Elsamadicy AA AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT. Electronic address: aladine.elsamadicy@yale.edu. FAU - Freedman, Isaac G AU - Freedman IG AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT. FAU - Koo, Andrew B AU - Koo AB AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT. FAU - David, Wyatt B AU - David WB AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT. FAU - Reeves, Benjamin C AU - Reeves BC AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT. FAU - Havlik, John AU - Havlik J AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT. FAU - Pennington, Zach AU - Pennington Z AD - Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD. FAU - Kolb, Luis AU - Kolb L AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT. FAU - Shin, John H AU - Shin JH AD - Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. FAU - Sciubba, Daniel M AU - Sciubba DM AD - Department of Neurosurgery, John Hopkins School of Medicine, Baltimore, MD. LA - eng PT - Journal Article DEP - 20210516 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Adolescent MH - Adult MH - Decompression MH - *Frailty/diagnosis/epidemiology MH - Hospitals MH - Humans MH - Length of Stay MH - Patient Readmission MH - Postoperative Complications/epidemiology MH - Retrospective Studies MH - *Spondylolisthesis/surgery OTO - NOTNLM OT - 30-Day readmission rate OT - Complications OT - Hospital Length of Stay OT - Modified frailty index OT - Posterior lumbar decompression and fusion OT - Spondylolisthesis COIS- Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2021/05/20 06:00 MHDA- 2022/01/07 06:00 CRDT- 2021/05/19 20:10 PHST- 2021/03/03 00:00 [received] PHST- 2021/04/20 00:00 [revised] PHST- 2021/05/07 00:00 [accepted] PHST- 2021/05/20 06:00 [pubmed] PHST- 2022/01/07 06:00 [medline] PHST- 2021/05/19 20:10 [entrez] AID - S1529-9430(21)00242-4 [pii] AID - 10.1016/j.spinee.2021.05.011 [doi] PST - ppublish SO - Spine J. 2021 Nov;21(11):1812-1821. doi: 10.1016/j.spinee.2021.05.011. Epub 2021 May 16.