Comment on “A High Frailty Burden Is a Strong Predictor of Adverse Postoperative Outcomes in Geriatric Lumbar Spine Surgery: A Retrospective Cohort Study”
Aug 2026· Global Spine Journal· 0 citations· 1 references
Medicine
TL;DR
While the study successfully establishes a statistical association, it is believed a deeper discussion is warranted regarding the distinction between population-level risk markers and individual-level predictive tools, the robustness of the causal inference, and the holistic interpretation of surgical benefit.
Abstract
We read with great interest the recent article by Cho et al, which investigated the impact of frailty on the prognosis of elderly patients undergoing lumbar spine surgery. 1 The authors are to be commended for introducing the 5-factor Modified Frailty Index (mFI-5) into risk stratification and for employing Inverse Probability of Treatment Weighting (IPTW) to mitigate selection bias. Their finding that severe frailty (mFI-5 ≥ 3) is independently associated with hospitalization complications (OR 1.792, 95% CI 1.243–2.585, P = 0.002) adds valuable evidence to the growing body of literature concerning geriatric spine care. However, while the study successfully establishes a statistical association, we believe a deeper discussion is warranted regarding the distinction between population-level risk markers and individual-level predictive tools, the robustness of the causal inference, and the holistic interpretation of surgical benefit. We commend Cho et al for introducing frailty assessment into the risk stratification of elderly patients undergoing lumbar spine surgery, and their IPTW-adjusted analysis demonstrated that mFI-5 ≥ 3 was independently associated with hospitalization complications (OR 1.792,95% CI 1.243–2.585, P = 0.002). However, a clear distinction must be made between statistical association and individual-level predictive power. This OR value supports mFI-5 as an important risk biomarker but does not alone establish its ability to accurately predict complication occurrence in specific patients. Furthermore, the study did not report discrimination power, calibration, sensitivity, specificity, internal validity, or the incremental predictive value of mFI-5 relative to established metrics such as ASA-PS
Integrating serum albumin, hematocrit, BMI, spinal region, and procedure type with frailty indices enhances risk stratification and informs surgical planning, preoperative optimization, and patient counseling in this vulnerable population of patients.
A. Ghaith, Xinlan Yang, Yazan Alasadi et al.· European spine journal· 0 citations
Aims: Proximal femur fractures pose a major problem for geriatric patients due to both their increasing incidence and their adverse postoperative outcomes. Based on this, we aimed to demonstrate the prognostic value of the 5-factor modified frailty index (mFI-5) in patients with proximal femur fractures who were monitored in the postoperative intensive care unit (ICU) and to evaluate its relationship with clinical outcomes. Methods: This retrospective cohort study included 246 patients between August 2023 and February 2026. Demographic data, laboratory and clinical outcomes, and ICU and 90-day mortality rates were recorded. Receiver operating characteristic (ROC) curve analysis and logistic regression analysis were performed to assess the prognostic value of the mFI-5. Results: Twenty-seven patients (10.98%) died in the ICU. In patients with an mFI-5 score of ≥2, the need for vasopressors, invasive mechanical ventilation, and postoperative sepsis was significantly higher (p=0.008, p=0.01, and p=0.037, respectively). In addition, ICU mortality was also higher in this group (p=0.008). Upon examination of ROC curve analyses, the AUC value for mFI-5 was 0.706, and the cutoff value was 2 (p
Berkay Küçük, Osman Yağız Atlı· Journal of Medicine and Pall...· 0 citations
Frailty has become a relevant risk factor among older adults undergoing elective oncological surgery, as it reduces physiological reserve and increases vulnerability to postoperative complications. However, knowledge on screening instruments and multiprofessional preoperative management strategies remains scattered across the literature. This study aimed to analyze, through an integrative review, the scientific evidence indicating frailty as a predictor of complications in this population, as well as to identify the screening tools and multiprofessional care strategies employed. Searches were carried out in PubMed/MEDLINE, LILACS, Cochrane Library, SciELO, and the Virtual Health Library, using DeCS/MeSH descriptors combined through Boolean operators, considering studies published between 2016 and 2026. Results consistently confirmed frailty as a predictor of complications in surgeries. Instruments such as the Clinical Frailty Scale and the G8 proved effective for initial screening, directing vulnerable patients toward comprehensive geriatric assessment. Preoperative management delivered by coordinated, rather than merely juxtaposed, multiprofessional teams was associated with fewer complications and shorter hospital stay. It is concluded that systematic frailty screening, combined with coordinated multiprofessional management, should be incorporated as routine practice in the surgical planning of older cancer patients.
F. R. D. de Moraes, Matheus Nunes Neves, Gracilene Wanzeler Moia et al.· Revista de Estudos Interdisc...· 0 citations
Frailty, a prevalent geriatric syndrome, increases susceptibility to adverse outcomes like mortality, cardiovascular disease, and hospitalization. This study evaluated the Fried frailty phenotype and its components’ association with clinical outcomes, focusing on mortality.
We conducted a systematic review and meta-analysis of studies on individuals aged 50 or more from databases searched up to October 2024. Included studies assessed at least one frailty criterion (weakness, slowness, exhaustion, physical inactivity, weight loss) and reported hazard ratios (HRs) for mortality or other outcomes. Random-effects models and subgroup analyses (e.g., heart failure, chronic kidney disease) were employed.
From 3445 articles, 36 studies were included. All frailty components are significantly associated with all-cause mortality: weakness (HR: 1.44, 95%CI: 1.30–1.59, p < 0.01), slowness (HR: 1.75, 95%CI: 1.56–1.95, p < 0.01), exhaustion (HR: 1.47, 95%CI: 1.29–1.68, p < 0.01), physical inactivity (HR: 1.72, 95%CI: 1.55–1.92, p < 0.01), and weight loss (HR: 1.56, 95%CI: 1.31–1.84, p < 0.01). Slowness, weakness, and physical inactivity were linked to cardiovascular mortality (HRs: 1.97, 1.45, 1.26, respectively, p < 0.01), while slowness and exhaustion were also linked to an increased risk of hospitalization (HRs: 1.46, 1.25, p < 0.01). Slowness was associated with a two-fold higher mortality risk (I2 = 57%, HR: 1.99, 95%CI: 1.73–2.30, p < 0.01). Subgroup analyses confirmed these links in heart failure and chronic kidney disease patients.
Frailty components, especially weakness and slowness, are significantly associated with mortality and related outcomes, highlighting the urgency of early frailty detection to improve patient prognosis.
This systematic review and meta-analysis of 36 studies demonstrates that the components of frailty, when considered individually, are significantly associated with an increased mortality risk; weakness (HR: 1.44), slowness (HR: 1.75), exhaustion (HR: 1.47), physical inactivity (HR: 1.72), and unintentional weight loss (HR: 1.56). Slowness and weakness are also associated with cardiovascular mortality and hospitalization, with slowness associated with a two-fold higher mortality risk in community-dwelling older adults (HR: 1.99). These robust associations, confirmed in heart failure and chronic kidney disease subgroups, highlight frailty's critical role in adverse outcomes, urging early identification and intervention to enhance patient care and reduce clinical burden.
K. Prokopidis, Francesco Saverio Ragusa, Roberta Bonica et al.· Aging Clinical and Experimen...· 0 citations
Abstract Introduction Metastatic spine disease (MSD) is increasingly common as new targeted therapies allow our patients to live to an elderly age, many with medical comorbidities. Frailty and sarcopenia are known predictors of worse surgical outcomes in degenerative and deformity-related populations, however, this relationship is less clear in the patients with MSD. We sought to review the literature detailing measurements of frailty and sarcopenia in the MSD population. Methods A systematic review of studies published from January 1, 2000 until June 2022 was performed. Among other study characteristics, frailty tools and measurements quantifying sarcopenia were collected. Clinimetric assessment was performed according to the Consensus-based Standards for Health Measurement Instruments. Results A total of 22 studies were included, consisting of over 45,000 patients. Seventeen (77%) of studies employed six frailty tools, the three most common of which were the Metastatic Spine Tumor Frailty Index (MSTFI), Modified Frailty Index-11 (mFI-11), and the mFI-5. The overall mean prevalence of frailty across cohorts was 69%, ranging from 21-100%, and the above tools were found to infrequently predict studied outcomes. Eight (36.4%) studies measured sarcopenia, most commonly the L3-Total Psoas Area (TPA) / Vertebral Body Area (VBA). The majority of sarcopenia measures also did not predict outcomes. No frailty tool received positive ratings for all clinimetric properties. Conclusion Frailty and sarcopenia are common in the MSD population and multidimensional measurements of health that must be carefully considered with regard to treatment decision making. However, this review reinforces the lack of readily available tool to quantify both conditions and their effect on outcomes. Standardization of tools that quantify these conditions will allow us to employ better surgical decision making and accurately measure the impact of frailty on clinical outcomes.
Eli Johnson, Mark A. Maclean, Antoinette J. Charles et al.· Neuro-Oncology Advances· 0 citations
Background The relationship between frailty and healthcare resource utilization in older patients with colorectal cancer (CRC) remains insufficiently quantified. We evaluated the associations of frailty with high inpatient costs, length of stay (LOS), and adverse events, and examined the explanatory roles of co-occurring comorbidity burden and postoperative complications. Methods This multicenter retrospective study analyzed 4,936 patients aged ≥60 years undergoing elective CRC surgery between 2014 and 2024. Hierarchical multivariable regression models evaluated associations between frailty and outcomes. Mediation-style decomposition was used to estimate the extent to which comorbidity burden and postoperative complications explained frailty-associated differences in high inpatient costs and LOS. A simulation-based sensitivity analysis was performed to assess the potential impact of ICD-10-based frailty misclassification. A Bonferroni-corrected threshold of p < 0.006 was applied. Results Frailty was significantly associated with high inpatient costs (OR = 1.274, 95% CI: 1.083–1.498, p = 0.003), prolonged LOS (log-transformed β = 0.082, 95% CI: 0.053–0.111, p < 0.001), and adverse events (OR = 3.317, 95% CI: 2.267–4.854, p < 0.001). Mediation-style decomposition showed that co-occurring comorbidity burden explained 28.6% of frailty-associated difference in high inpatient costs (p < 0.001). Postoperative complications did not significantly explain the frailty–LOS association (3.8%, p = 0.368). The estimated excess socioeconomic burden associated with frailty was CNY 657 million. In the sensitivity analysis, the direction of frailty associations with all three outcomes remained unchanged across simulated ICD-10 misclassification scenarios, although the association with high inpatient costs was attenuated under moderate and severe assumptions. Conclusion Frailty was associated with increased healthcare resource utilization and adverse outcomes in older CRC patients. Co-occurring comorbidity burden partly explained the frailty-associated difference in high inpatient costs, whereas prolonged LOS was not significantly explained by postoperative complications. These findings support routine frailty screening and dual-track perioperative optimization targeting both comorbidity burden and frailty-related physiological vulnerability.
Yixiang Huang, Jian-chao Liu, Run-da Jiao et al.· Frontiers in Medicine· 0 citations