Modified Five-item Frailty Index (mFI-5) versus Grip Strength as predictors of length of stay, discharge to home, and early surgical complications in patients undergoing long segment fusion

Abstract

Objectives

In this paper, the authors aim to compare the ability of grip strength and the Modified Five-Item Frailty Index (mFI-5) to predict outcomes and complications in patients undergoing long segment spinal fusion.

Methods

An IRB-approved chart review was conducted to collect data on patient grip strength, comorbidities, and post-operative course. Hand grip strength was measured with the Camry Digital Hand Dynamometer. Descriptive statistics were performed with IBM SPSS Statistics Software and required Student’s t-test, Pearson’s correlation coefficient, and Spearman’s correlation coefficient.

Results

Patients with an increased grip strength were significantly more likely to be discharged to home as opposed to a rehabilitation facility, while patients with decreased frailty had no increased likelihood of being discharged home. Both grip strength and frailty predicted neurocritical care unit (NCCU) and total hospital stay length. Although the average grip strength was not strongly correlated with days to ambulation, right-hand strength and frailty were.

Conclusion

Although both increased grip strength and decreased frailty are correlated with decreased NCCU stay, only increased grip strength is associated with a higher likelihood of patients returning home postoperatively. Therefore, maximal grip strength is likely a superior predictor of postoperative outcomes than a frailty index such as the mFI-5. Given the ease of grip strength measurement and its reflection of a patient’s present physical state, it is likely a very robust measure of a patient’s individual preparedness for the physiologic toll of surgery and can be easily incorporated into a pre-operative evaluation.