Optimization is a Moving Target: A Continuous Modifiable Frailty Index (o-ASD-FI) Reflecting Optimization Prior to Complex Adult Spinal Deformity (ASD) Intervention.

Authors

Peter Passias, Kara Ashcraft, Marcel Dreischarf, Mohammad Daher, Justin Smith, Renaud Lafage, Bassel Diebo, Alan H Daniels, Peter Tretiakov, Francesca Totis, Kojo D Hamilton, Breton Line, Thomas Buell, Juan Uribe, Michael Wang, Richard Fessler, Pierce Nunley, Neel Anand, Robert Eastlack, Gregory Mundis, David Okonkwo, Khaled Kebaish, Alex Soroceanu, Justin Scheer, Jeffrey Mullin, Praveen Mummaneni, Dean Chou, Han Jo Kim, Richard Hostin, Munish Gupta, Lawrence Lenke, Douglas Burton, Frank Schwab, Christopher Ames, Virginie Lafage, Christopher Shaffrey, Shay Bess, International Spine Study Group

Published in

Spine. Sep 07, 2026. Epub Sep 07, 2026.

Abstract

Retrospective analysis of a multicenter complex adult spinal deformity (ASD) cohort.
Develop a simplified, weighted, and modifiable ASD Frailty Index (o-ASD-FI) that incorporates modifiable health components.
Though newer frailty indices have emerged, none specifically addresses complex ASD while incorporating modifiable health factors.
Miller's ASD-FI variables were evaluated via Pearson bivariate correlation and multiple stepwise regression. Ten frailty and three modifiable health factors (depression, diabetes, and osteoporosis) were identified and regressed against mortality, extended length of stay (LOS > 8 d), revisions, and major complications. Coefficients were weighted using Johnson's method to create the o-ASD-FI (range: 0 - 18). Frailty categories were defined as: not frail (<2), frail (≥2 and <7), and severely frail (≥7). Associations between frailty and pre- and postoperative factors were assessed via ANOVA.
Among 572 patients (mean ± SD age 60.6±15.7 years, BMI 27.3±5.4 kg/m², LOS 7.2±5.0 d), the final model explained 80.6% of the variance in the ASD-FI score. Key contributors (weights): smoking (3), osteoporosis (3), diabetes (2), cardiac disease (2), lifting impairment (2), leg weakness (2), disability (1), stair difficulty (1), depression (1), BMI extremes (1), and optimized depression, osteoporosis, or diabetes (-1 each). Mean o-ASD-FI score: 3.4±2.1. Most patients were frail (72.2%); 20.5% not frail, 7.3% severely frail. Greater frailty correlated with longer LOS (P<0.001), worse HRQoL (P<0.001), and poorer alignment (P<0.05). Frailty independently predicted higher odds of spine (OR 1.2), medical (1.09), intraoperative (1.1), and in-hospital adverse events (1.1), all P<0.01.
The newly developed simplified, weighted, and optimizable ASD Frailty Index (o-ASD-FI) incorporates modifiable health components, providing a robust assessment of physiological status and potentially superior risk stratification compared with existing tools for both primary and revision complex spinal deformity surgery.
III.

PMID:
42704893
Bibliographic data and abstract were imported from PubMed on 08 Sep 2026.

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