Predictive value of frailty indices for postoperative outcomes of metastatic spine tumor: a systematic review and meta-analysis.
Source: PubMed, NCBI / U.S. National Library of Medicine
Surgical management of spinal metastases aims to palliate symptoms but poses significant perioperative risks. Traditional tools like survival scores and comorbidity indices inadequately capture the multidimensional frailty in cancer patients, prompting interest in frailty indices for risk stratification. This meta-analysis evaluates the predictive value of frailty indices for postoperative outcomes in spinal metastasis surgery. Adhering to PRISMA guidelines, PubMed, Embase, Cochrane Library, and other databases were systematically searched until May 2025. Observational clinical studies reporting frailty indices and postoperative outcomes (complications, LOS, nonroutine discharge, and survival rate) in spinal metastasis surgery were included. Study quality was assessed via Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated using fixed-effect model. A total of 12 studies involving 17,446 patients were included. The predictive value of several frailty indices, such as the 5-item/ 11-item modified frailty index (mFI-5/mFI-11), Metastatic Spinal Tumor Frailty Index (MSTFI), and Johns Hopkins Adjusted Clinical Groups (JHACG), were assessed. Some of the frailty indices predicted adverse outcomes: prolonged LOS (mFI-5 OR = 1.67, p = 0.014; JHACG OR = 2.65, p < 0.001), nonroutine discharge (MSTFI OR = 1.59, JHACG OR = 1.79; all p < 0.001), and complications (mFI-11 OR 
Abstract
Surgical management of spinal metastases aims to palliate symptoms but poses significant perioperative risks. Traditional tools like survival scores and comorbidity indices inadequately capture the multidimensional frailty in cancer patients, prompting interest in frailty indices for risk stratification. This meta-analysis evaluates the predictive value of frailty indices for postoperative outcomes in spinal metastasis surgery. Adhering to PRISMA guidelines, PubMed, Embase, Cochrane Library, and other databases were systematically searched until May 2025. Observational clinical studies reporting frailty indices and postoperative outcomes (complications, LOS, nonroutine discharge, and survival rate) in spinal metastasis surgery were included. Study quality was assessed via Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated using fixed-effect model. A total of 12 studies involving 17,446 patients were included. The predictive value of several frailty indices, such as the 5-item/ 11-item modified frailty index (mFI-5/mFI-11), Metastatic Spinal Tumor Frailty Index (MSTFI), and Johns Hopkins Adjusted Clinical Groups (JHACG), were assessed. Some of the frailty indices predicted adverse outcomes: prolonged LOS (mFI-5 OR = 1.67, p = 0.014; JHACG OR = 2.65, p < 0.001), nonroutine discharge (MSTFI OR = 1.59, JHACG OR = 1.79; all p < 0.001), and complications (mFI-11 OR = 2.94, p = 0.003; MSTFI OR = 1.42, p < 0.001; JHACG OR = 1.54, p < 0.001). Survival prediction was inconsistent; only MSTFI correlated with 30-day mortality in one study (p < 0.05). Synthesized evidence from observational studies suggests that frailty indices were potential prognostic factors to predict post-operative morbidity, LOS, and discharge complexity. However, survival prognostication remains limited by tumor biology variability and methodological heterogeneity. Future efforts should integrate frailty assessments with tumor-specific factors to enhance prognostic precision and guide personalized perioperative optimization.