The Influence of Frailty on Outcomes of Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis Publisher Pubmed



Rashidi F ; Babu YSR ; Delbari P ; Sabahi M ; Rubio DTS ; Durrani MH ; Yusuf F ; Cuello CC ; Choi H ; Kim DH ; Yu A ; Alikhani P
Source: Neurosurgical Review Published:2026

Abstract

Purpose Adult spinal deformities (ASDs) pose a growing healthcare challenge due to their high prevalence and significant impact on quality of life. Although conservative management is often preferred initially, surgery becomes essential for patients with severe or unresponsive symptoms. However, surgical intervention in elderly populations introduces unique risks due to age-associated comorbidities and the complexity of spinal deformity correction. Recent evidence suggests that frailty could provide more accurate predictions of post-operative outcomes than chronological age alone, yet the exact role of frailty in ASD surgeries remains underexamined. This study aims to review the outcomes of ASD surgery in frail and non-frail population. Methods Following PRISMA guidelines, a systematic search was conducted across Embase, Scopus, Web of Science, and PubMed up until September 15th, 2024, using relevant key terms. The quality of studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Results Of 1,422 retrieved records, 19 studies met the inclusion criteria. This systematic review includes 17,473 patients aged 44 to 78 years, using different frailty indices, with follow-up ranging from two months to four years. There were no statistically significant differences regarding peri-operative metrics, such as duration of surgery, length of hospitalization, estimated blood loss, and reoperations between frail and non-frail patients. However, procedure-related complications (risk difference of 21%; 95% CI: 0.09, 0.33; p = 0.0008) were significantly higher in the frail group. In addition, there were no significant differences regarding biometric changes. The mean difference of Oswestry Disability Index and Scoliosis Research Society 22 questionnaire changes were not statistically significant in frail vs. non-frail patients. Conclusion Although frailty does not appear to substantially affect certain peri-operative metrics such as blood loss and length of hospitalization, it is associated with significantly higher complications. These findings underscore the need to consider frailty as a predictor of short-term surgical risk rather than long-term outcomes, highlighting the potential for a more nuanced approach in managing and counseling frail patients in this population. © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2025.