Performance of the Modified Adult Spinal Deformity Frailty Index in Preoperative Risk Assessment

Peter G. Passias, Kevin Moattari, Katherine E. Pierce, Lara Passfall, Oscar Krol, Sara Naessig, Waleed Ahmad, Andrew J. Schoenfeld, Salman Ahmad, Vivek Singh, Rachel Joujon-Roche, Tyler K. Williamson, Bailey Imbo, Peter Tretiakov, Shaleen Vira, Bassel Diebo, Renaud Lafage, Virginie Lafage

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Study Design. Retrospective single-center, consecutively enrolled database of adult spinal deformity (ASD) patients. Objective. The aim of this study was to assess the performance of the mASD-FI in predicting clinical and patient-reported outcomes after ASD-corrective surgery. Summary of Background Data. The recently described modified Adult Spinal Deformity frailty index (mASD-FI) quantifies frailty of ASD patients, but the utility of this clinical prediction tool as a means of prognosticating postoperative outcomes has not been investigated. Methods. ASD patients with available mASD-FI scores and HRQL data at presentation and 2-years postop were included. Patients were stratified by mASD-FI score using published cutoffs: not frail (NF <7), frail (F, 7-12), severely frail (SF, >12). Analysis of vaiance assessed differences in patient factors across frailty groups. Linear regression assessed the relationship of mASD-FI with length of stay (LOS) and HRQLs. Multivariable logistic regression revealed how frailty category predicted odds of complications, infections and reoperation. Results. A total of 509 patients included (59 years, 79%F, 27.7 kg/m2). The cohort presented with moderate baseline deformity: sagittal vertical axis (83.7 mm ± 71), PT (12.7° ± 10.8°), PI-LL (43.1° ± 21.1°). Mean preoperative mASD-FI score was 7.2, frailty category: NF (50.3%), F (34.0%), SF (15.7%). Age, BMI, and Charlson Comorbidity Index increased with frailty categories (all P < 0.001); however, fusion length (P = 0.247) and osteotomy rate (P = 0.731) did not. At baseline, increasing frailty was associated with inferior Oswestry Disability Index (ODI), EuroQol 5-Dimension Questionnaire (EQ-5D), SRS-22r, Pain Catastrophizing Scale, and NRS Back and Leg (all P < 0.001). Greater frailty was associated with increased LOS and reduced postoperative HRQL. Controlling for complication incidence, baseline mASD-FI predicted 2 year postop scores for year ODI (b = 0.7, 0.58-0.8, P < 0.001) SRS (b = a '0.023, a '0.03 to a '0.02, P < 0.001), EQ-5D (b = a '0.003, a '0.004 to a '0.002, P < 0.001). F and SF were associated with greater odds of unplanned revision surgery and complications. Conclusion. Higher preoperative mASD-FI score was associated with significantly greater complications, higher rate of unplanned reoperations and lower postoperative HRQL in this investigation. The mASD-FI provides similar prognostic utility while reducing burden for surgeons and patients.

Original languageEnglish (US)
Pages (from-to)1463-1469
Number of pages7
Issue number20
StatePublished - Oct 15 2022
Externally publishedYes


  • complications
  • deformity
  • frailty
  • fusion
  • HRQL
  • spine.

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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