Frailty is Associated with Longer Hospital Stays and Non-Home Discharge Disposition in Patients Undergoing Surgery for Cervical Myelopathy

Introduction: The modified 5-item frailty index (mFI-5) has become a useful tool in evaluating the likelihood of adverse outcomes following surgery. Studies, including large national databases, have shown that frailty affects post-operative outcomes in patients with cervical myelopathy. In this study, we examine the impact of frailty on post-operative length of stay and discharge disposition in patients undergoing surgical treatment of cervical myelopathy at a large, single-center academic institution.

Methods: A retrospective, single-center study identified adult patients who underwent decompression for cervical myelopathy between 2016 and 2020. Cohort characteristics were collected from patients’ medical charts. The mFI-5 score included five major comorbidities: congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, functional status, and hypertension requiring medication. ANOVA and Kruskal–Wallis tests were used to compare continuous variables, while chi-squared tests were used to evaluate categorical variables. A multivariate linear regression was used to evaluate length of hospital stay while controlling for patient characteristics. All statistical analysis was performed in MATLAB.

Results: 494 patients were included in the study with a male predominance of n=302 (61.1%) and median age of 65 years old (range of 18-96 years). Ninety-eight patients had an mFI-5 score of 0 (not frail), while 240 and 156 had scores of 1 (pre-frail) and >= 2 (frail), respectively. Frailty was associated with longer durations of hospital stay, with patients of mFI-5 0 or 1 having a median hospital stay of 3 days compared to 4 days in patients with mFI-5 >= 2 (p < 0.001). Frailty was also associated with increased death (p < 0.001) and discharge to a rehabilitation facility (p < 0.001). On multivariate analysis, frailty was the only variable significantly associated with duration of hospital stay (p < 0.001), while age, sex, and race had no significant relationship.

Conclusion : The results of our study suggest that frailty is a significant factor affecting length of stay and discharge to rehabilitation facilities in patients with cervical myelopathy. This should be considered in perioperative planning to improve length of stay, facilitate safe discharges, and support transitions to home. In doing so, evaluating frailty can serve as a useful tool for patients, providers, and hospital systems alike.