{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T20:57:01Z","timestamp":1780520221399,"version":"3.54.1"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The objective of this study was to assess the complicated relationship between frailty, perioperative complications, and patient-reported outcomes (PROs) in elderly patients (\u2265 75 years old) undergoing lumbar spine fusion (LSF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Consecutive patients who underwent LSF between March 2019 and December 2021 were recruited in this study. Frail patients (modified frailty index [mFI] score \u2265 2) were propensity score matched to nonfrail patients (mFI score 0\u20131) on the basis of age, sex, and the number of fused levels. Perioperative complications were collected and assessed according to the comprehensive complication index. Subgroups were further subdivided on the basis of the presence of major complications. The data from SF-36, Oswestry Disability Index (ODI), and North American Spine Society Satisfaction Questionnaire (NASS) at baseline and 1- and 2-year follow-up evaluations were compared between groups. Furthermore, the minimal clinically important difference (MCID) achievement rate was also compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The final analysis included 631 patients: 344 in the frail group and 287 in the nonfrail group. Frail patients were older (79.7 \u00b1 5.1 years vs 76.4 \u00b1 4.8 years, p &lt; 0.001), with a higher proportion of females (68.9% vs 57.8%, p = 0.004) and those with malnutrition (17.7% vs 11.1%, p = 0.020). After propensity score matching for age, sex, and number of fused levels, 402 patients (201 in each group) were analyzed. Frail patients were more prone to have delirium (7.5% vs 3.0%, p = 0.044), blood transfusion (43.3% vs 30.3%, p = 0.007), and surgical site infection (6.0% vs 2.0%, p = 0.041). In addition, frail patients had a higher proportion of major complications (29.4% vs 16.9%, p = 0.003). Although they had worse PROs at baseline, frail patients obtained higher mean improvements and higher rates of MCID achievement by the 1- and 2-year follow-up evaluations than their nonfrail counterparts. Major complications did not seem to affect PROs in frail and nonfrail patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Despite being associated with worse baseline PROs, frail patients gained greater mean improvement in PROs and higher rates of MCID achievement by the 1- and 2-year follow-up evaluations than nonfrail patients. In addition, the presence of major complications did not affect PROs at the 1- and 2-year follow-ups. Although associated with major complications, elderly patients with frailty could benefit from LSF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.9.spine24858","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T20:55:00Z","timestamp":1735937700000},"page":"348-355","source":"Crossref","is-referenced-by-count":3,"title":["The recovery trajectory of patient-reported outcomes in elderly patients with frailty undergoing lumbar spine fusion: a propensity score\u2013matching analysis"],"prefix":"10.3171","volume":"42","author":[{"given":"Peng","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shibao","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Eur Spine J","first-page":"2242","article-title":"Frailty is not an independent risk factor for worse clinical outcomes in lumbar spinal surgery: a prospective cohort study","volume":"33","author":"Shin HK","year":"2024","unstructured":"Shin HK, Baek JY, Kim JH,  Frailty is not an independent risk factor for worse clinical outcomes in lumbar spinal surgery: a prospective cohort study. Eur Spine J. 2024;33(6):2242\u20132250."},{"issue":"11","key":"b2","series-title":"Aging Clin Exp Res","first-page":"2583","article-title":"A comparison of radiographic degeneration features of older Chinese women and older Italian Caucasian women with a focus on thoracic spine","volume":"35","author":"W\u00e1ng YXJ","year":"2023","unstructured":"W\u00e1ng YXJ, Diacinti D, Iannacone A,  A comparison of radiographic degeneration features of older Chinese women and older Italian Caucasian women with a focus on thoracic spine. Aging Clin Exp Res. 2023;35(11):2583\u20132591."},{"issue":"20","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"1410","article-title":"Frailty and sarcopenia: impact on outcomes following elective degenerative lumbar spine surgery","volume":"47","author":"Chotai S","year":"2022","unstructured":"Chotai S, Gupta R, Pennings JS,  Frailty and sarcopenia: impact on outcomes following elective degenerative lumbar spine surgery. Spine (Phila Pa 1976). 2022;47(20):1410\u20131417."},{"issue":"5","key":"b4","series-title":"Spine J","first-page":"739","article-title":"Frailty measured by risk analysis index and adverse discharge outcomes after adult spine deformity surgery: analysis of 3104 patients from a prospective surgical registry (2011-2020)","volume":"23","author":"Covell MM","year":"2023","unstructured":"Covell MM, Rumalla K, Kassicieh AJ,  Frailty measured by risk analysis index and adverse discharge outcomes after adult spine deformity surgery: analysis of 3104 patients from a prospective surgical registry (2011-2020). Spine J. 2023;23(5):739\u2013745."},{"issue":"2","key":"b5","series-title":"Spine J","first-page":"325","article-title":"Predicting major complications and discharge disposition after adult spinal deformity surgery","volume":"24","author":"Vadhera AS","year":"2024","unstructured":"Vadhera AS, Sachdev R, Andrade NS,  Predicting major complications and discharge disposition after adult spinal deformity surgery. Spine J. 2024;24(2):325\u2013329."},{"issue":"10206","key":"b6","series-title":"Lancet","first-page":"1376","article-title":"Management of frailty: opportunities, challenges, and future directions","volume":"394","author":"Dent E","year":"2019","unstructured":"Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376\u20131386."},{"issue":"12","key":"b7","series-title":"Spine J","first-page":"1778","article-title":"A comprehensive analysis of the triad of frailty, aging, and obesity in spine surgery: the risk analysis index predicted 30-day mortality with superior discrimination","volume":"23","author":"Owodunni OP","year":"2023","unstructured":"Owodunni OP, Yocky AG, Courville EN,  A comprehensive analysis of the triad of frailty, aging, and obesity in spine surgery: the risk analysis index predicted 30-day mortality with superior discrimination. Spine J. 2023;23(12):1778\u20131789."},{"issue":"5","key":"b8","series-title":"Neurosurgery","first-page":"693","article-title":"Highest achievable outcomes for patients undergoing cervical deformity corrective surgery by frailty","volume":"91","author":"Passias PG","year":"2022","unstructured":"Passias PG, Kummer N, Williamson TK,  Highest achievable outcomes for patients undergoing cervical deformity corrective surgery by frailty. Neurosurgery. 2022;91(5):693\u2013700."},{"issue":"2","key":"b9","series-title":"Neurosurgery","first-page":"480","article-title":"Identifying subsets of patients with adult spinal deformity who maintained a positive response to nonoperative management","volume":"93","author":"Passias PG","year":"2023","unstructured":"Passias PG, Ahmad W, Tretiakov P,  Identifying subsets of patients with adult spinal deformity who maintained a positive response to nonoperative management. Neurosurgery. 2023;93(2):480\u2013488."},{"issue":"4","key":"b10","series-title":"J Neurosurg Spine","first-page":"599","article-title":"Proximal and distal reciprocal changes following cervical deformity malalignment correction","volume":"37","author":"Lafage R","year":"2022","unstructured":"Lafage R, Smith JS, Fong AM,  Proximal and distal reciprocal changes following cervical deformity malalignment correction. J Neurosurg Spine. 2022;37(4):599\u2013606."},{"issue":"11","key":"b11","series-title":"Eur Spine J","first-page":"3060","article-title":"Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis","volume":"31","author":"Murata S","year":"2022","unstructured":"Murata S, Tsutsui S, Hashizume H,  Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis. Eur Spine J. 2022;31(11):3060\u20133068."},{"key":"b12","series-title":"Global Spine J","article-title":"The 5-factor modified frailty index is associated with increased risk of reoperations and adjacent level disease following single-level transforaminal lumbar interbody fusion","author":"Patel N","unstructured":"Patel N, Coban D, Changoor S, Sinha K, Hwang KS, Emami A. The 5-factor modified frailty index is associated with increased risk of reoperations and adjacent level disease following single-level transforaminal lumbar interbody fusion. Global Spine J. Published online August 19, 2023. doi:10.1177\/21925682231196828"},{"issue":"1","key":"b13","series-title":"Ann Surg","first-page":"1","article-title":"The comprehensive complication index: a novel continuous scale to measure surgical morbidity","volume":"258","author":"Slankamenac K","year":"2013","unstructured":"Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1\u20137."},{"key":"b14","series-title":"Front Surg","first-page":"997657","article-title":"Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol","volume":"9","author":"Cui P","year":"2022","unstructured":"Cui P, Wang S, Wang P, Yang L, Kong C, Lu S. Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol. Front Surg. 2022;9:997657."},{"issue":"12","key":"b15","series-title":"Lancet Public Health","first-page":"e650","article-title":"Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study","volume":"5","author":"Fan J","year":"2020","unstructured":"Fan J, Yu C, Guo Y,  Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study. Lancet Public Health. 2020;5(12):e650\u2013e660."},{"issue":"1","key":"b16","series-title":"J Neurosurg Spine","first-page":"136","article-title":"Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery","volume":"39","author":"Bowers CA","year":"2023","unstructured":"Bowers CA, Varela S, Conlon M,  Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery. J Neurosurg Spine. 2023;39(1):136\u2013145."},{"issue":"7","key":"b17","series-title":"Eur Spine J","first-page":"2266","article-title":"The relationship between frailty and spinal alignment in the elderly general population: a two-year longitudinal study","volume":"32","author":"Oe S","year":"2023","unstructured":"Oe S, Yamato Y, Hasegawa T,  The relationship between frailty and spinal alignment in the elderly general population: a two-year longitudinal study. Eur Spine J. 2023;32(7):2266\u20132273."},{"issue":"3","key":"b18","series-title":"Neurosurgery","first-page":"552","article-title":"Impact of frailty on outcomes following spine surgery: a prospective cohort analysis of 668 patients","volume":"88","author":"Agarwal N","year":"2021","unstructured":"Agarwal N, Goldschmidt E, Taylor T,  Impact of frailty on outcomes following spine surgery: a prospective cohort analysis of 668 patients. Neurosurgery. 2021;88(3):552\u2013557."},{"issue":"6","key":"b19","series-title":"J Neurosurg Spine","first-page":"667","article-title":"Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors","volume":"15","author":"Acosta FL Jr","year":"2011","unstructured":"Acosta FL Jr, McClendon J Jr, O\u2019Shaughnessy BA,  Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine. 2011;15(6):667\u2013674."},{"issue":"4","key":"b20","series-title":"Spine J","first-page":"582","article-title":"The frailty-driven predictive model for failure to rescue among patients who experienced a major complication following cervical decompression and fusion: an ACS-NSQIP analysis of 3,632 cases (2011\u20132020)","volume":"24","author":"Rumalla KC","year":"2024","unstructured":"Rumalla KC, Covell MM, Skandalakis GP,  The frailty-driven predictive model for failure to rescue among patients who experienced a major complication following cervical decompression and fusion: an ACS-NSQIP analysis of 3,632 cases (2011\u20132020). Spine J. 2024;24(4):582\u2013589."},{"key":"b21","series-title":"Neurosurgery","article-title":"Elderly patients show substantial improvement in health-related quality of life after surgery for degenerative cervical myelopathy despite medical frailty: an ambispective analysis of a multicenter, international data set","author":"Pedro KM","unstructured":"Pedro KM, Alvi MA, Hejrati N, Moghaddamjou A, Fehlings MG. Elderly patients show substantial improvement in health-related quality of life after surgery for degenerative cervical myelopathy despite medical frailty: an ambispective analysis of a multicenter, international data set. Neurosurgery. Published online January 10, 2024. doi:10.1227\/neu.0000000000002818"},{"issue":"8","key":"b22","series-title":"Qual Life Res","first-page":"2041","article-title":"Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis","volume":"28","author":"Crocker TF","year":"2019","unstructured":"Crocker TF, Brown L, Clegg A,  Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. Qual Life Res. 2019;28(8):2041\u20132056."},{"issue":"5","key":"b23","series-title":"J Neurosurg Spine","first-page":"607","article-title":"The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery","volume":"35","author":"Beauchamp-Chalifour P","year":"2021","unstructured":"Beauchamp-Chalifour P, Flexman AM, Street JT,  The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery. J Neurosurg Spine. 2021;35(5):607\u2013615."},{"issue":"2","key":"b24","series-title":"Neurosurgery","first-page":"420","article-title":"The effect of perioperative adverse events on long-term patient-reported outcomes after lumbar spine surgery","volume":"88","author":"Ayling OGS","year":"2021","unstructured":"Ayling OGS, Ailon T, Street JT,  The effect of perioperative adverse events on long-term patient-reported outcomes after lumbar spine surgery. Neurosurgery. 2021;88(2):420\u2013427."},{"issue":"1","key":"b25","series-title":"BMC Geriatr","first-page":"771","article-title":"Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis","volume":"23","author":"Baek W","year":"2023","unstructured":"Baek W, Park SY, Kim Y. Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis. BMC Geriatr. 2023;23(1):771."},{"issue":"4","key":"b26","series-title":"Neurospine","first-page":"1337","article-title":"A predictive model of failure to rescue after thoracolumbar fusion","volume":"20","author":"Roy JM","year":"2023","unstructured":"Roy JM, Segura AC, Rumalla K, Skandalakis GP, Covell MM, Bowers CA. A predictive model of failure to rescue after thoracolumbar fusion. Neurospine. 2023;20(4):1337\u20131345."},{"issue":"1","key":"b27","series-title":"J Neurosurg Anesthesiol","first-page":"19","article-title":"Frailty assessment and prehabilitation before complex spine surgery in patients with degenerative spine disease: a narrative review","volume":"35","author":"Mohamed B","year":"2023","unstructured":"Mohamed B, Ramachandran R, Rabai F,  Frailty assessment and prehabilitation before complex spine surgery in patients with degenerative spine disease: a narrative review. J Neurosurg Anesthesiol. 2023;35(1):19\u201330."},{"issue":"2","key":"b28","series-title":"Age Ageing","first-page":"afae011","article-title":"Summary of best evidence for prevention and management of frailty","volume":"53","author":"Guo Y","year":"2024","unstructured":"Guo Y, Miao X, Hu J,  Summary of best evidence for prevention and management of frailty. Age Ageing. 2024;53(2):afae011."},{"issue":"6","key":"b1","series-title":"Eur Spine J","first-page":"2242","article-title":"Frailty is not an independent risk factor for worse clinical outcomes in lumbar spinal surgery: a prospective cohort study","volume":"33","author":"Shin HK","year":"2024","unstructured":"Shin HK, Baek JY, Kim JH,  Frailty is not an independent risk factor for worse clinical outcomes in lumbar spinal surgery: a prospective cohort study. Eur Spine J. 2024;33(6):2242\u20132250."},{"issue":"11","key":"b2","series-title":"Aging Clin Exp Res","first-page":"2583","article-title":"A comparison of radiographic degeneration features of older Chinese women and older Italian Caucasian women with a focus on thoracic spine","volume":"35","author":"W\u00e1ng YXJ","year":"2023","unstructured":"W\u00e1ng YXJ, Diacinti D, Iannacone A,  A comparison of radiographic degeneration features of older Chinese women and older Italian Caucasian women with a focus on thoracic spine. Aging Clin Exp Res. 2023;35(11):2583\u20132591."},{"issue":"20","key":"b3","series-title":"Spine (Phila Pa 1976)","first-page":"1410","article-title":"Frailty and sarcopenia: impact on outcomes following elective degenerative lumbar spine surgery","volume":"47","author":"Chotai S","year":"2022","unstructured":"Chotai S, Gupta R, Pennings JS,  Frailty and sarcopenia: impact on outcomes following elective degenerative lumbar spine surgery. Spine (Phila Pa 1976). 2022;47(20):1410\u20131417."},{"issue":"5","key":"b4","series-title":"Spine J","first-page":"739","article-title":"Frailty measured by risk analysis index and adverse discharge outcomes after adult spine deformity surgery: analysis of 3104 patients from a prospective surgical registry (2011-2020)","volume":"23","author":"Covell MM","year":"2023","unstructured":"Covell MM, Rumalla K, Kassicieh AJ,  Frailty measured by risk analysis index and adverse discharge outcomes after adult spine deformity surgery: analysis of 3104 patients from a prospective surgical registry (2011-2020). Spine J. 2023;23(5):739\u2013745."},{"issue":"2","key":"b5","series-title":"Spine J","first-page":"325","article-title":"Predicting major complications and discharge disposition after adult spinal deformity surgery","volume":"24","author":"Vadhera AS","year":"2024","unstructured":"Vadhera AS, Sachdev R, Andrade NS,  Predicting major complications and discharge disposition after adult spinal deformity surgery. Spine J. 2024;24(2):325\u2013329."},{"issue":"10206","key":"b6","series-title":"Lancet","first-page":"1376","article-title":"Management of frailty: opportunities, challenges, and future directions","volume":"394","author":"Dent E","year":"2019","unstructured":"Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376\u20131386."},{"issue":"12","key":"b7","series-title":"Spine J","first-page":"1778","article-title":"A comprehensive analysis of the triad of frailty, aging, and obesity in spine surgery: the risk analysis index predicted 30-day mortality with superior discrimination","volume":"23","author":"Owodunni OP","year":"2023","unstructured":"Owodunni OP, Yocky AG, Courville EN,  A comprehensive analysis of the triad of frailty, aging, and obesity in spine surgery: the risk analysis index predicted 30-day mortality with superior discrimination. Spine J. 2023;23(12):1778\u20131789."},{"issue":"5","key":"b8","series-title":"Neurosurgery","first-page":"693","article-title":"Highest achievable outcomes for patients undergoing cervical deformity corrective surgery by frailty","volume":"91","author":"Passias PG","year":"2022","unstructured":"Passias PG, Kummer N, Williamson TK,  Highest achievable outcomes for patients undergoing cervical deformity corrective surgery by frailty. Neurosurgery. 2022;91(5):693\u2013700."},{"issue":"2","key":"b9","series-title":"Neurosurgery","first-page":"480","article-title":"Identifying subsets of patients with adult spinal deformity who maintained a positive response to nonoperative management","volume":"93","author":"Passias PG","year":"2023","unstructured":"Passias PG, Ahmad W, Tretiakov P,  Identifying subsets of patients with adult spinal deformity who maintained a positive response to nonoperative management. Neurosurgery. 2023;93(2):480\u2013488."},{"issue":"4","key":"b10","series-title":"J Neurosurg Spine","first-page":"599","article-title":"Proximal and distal reciprocal changes following cervical deformity malalignment correction","volume":"37","author":"Lafage R","year":"2022","unstructured":"Lafage R, Smith JS, Fong AM,  Proximal and distal reciprocal changes following cervical deformity malalignment correction. J Neurosurg Spine. 2022;37(4):599\u2013606."},{"issue":"11","key":"b11","series-title":"Eur Spine J","first-page":"3060","article-title":"Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis","volume":"31","author":"Murata S","year":"2022","unstructured":"Murata S, Tsutsui S, Hashizume H,  Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis. Eur Spine J. 2022;31(11):3060\u20133068."},{"key":"b12","series-title":"Global Spine J","article-title":"The 5-factor modified frailty index is associated with increased risk of reoperations and adjacent level disease following single-level transforaminal lumbar interbody fusion","author":"Patel N","unstructured":"Patel N, Coban D, Changoor S, Sinha K, Hwang KS, Emami A. The 5-factor modified frailty index is associated with increased risk of reoperations and adjacent level disease following single-level transforaminal lumbar interbody fusion. Global Spine J. Published online August 19, 2023. doi:10.1177\/21925682231196828"},{"issue":"1","key":"b13","series-title":"Ann Surg","first-page":"1","article-title":"The comprehensive complication index: a novel continuous scale to measure surgical morbidity","volume":"258","author":"Slankamenac K","year":"2013","unstructured":"Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien PA. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg. 2013;258(1):1\u20137."},{"key":"b14","series-title":"Front Surg","first-page":"997657","article-title":"Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol","volume":"9","author":"Cui P","year":"2022","unstructured":"Cui P, Wang S, Wang P, Yang L, Kong C, Lu S. Comparison of perioperative outcomes in frail patients following multilevel lumbar fusion surgery with and without the implementation of the enhanced recovery after surgery protocol. Front Surg. 2022;9:997657."},{"issue":"12","key":"b15","series-title":"Lancet Public Health","first-page":"e650","article-title":"Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study","volume":"5","author":"Fan J","year":"2020","unstructured":"Fan J, Yu C, Guo Y,  Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study. Lancet Public Health. 2020;5(12):e650\u2013e660."},{"issue":"1","key":"b16","series-title":"J Neurosurg Spine","first-page":"136","article-title":"Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery","volume":"39","author":"Bowers CA","year":"2023","unstructured":"Bowers CA, Varela S, Conlon M,  Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery. J Neurosurg Spine. 2023;39(1):136\u2013145."},{"issue":"7","key":"b17","series-title":"Eur Spine J","first-page":"2266","article-title":"The relationship between frailty and spinal alignment in the elderly general population: a two-year longitudinal study","volume":"32","author":"Oe S","year":"2023","unstructured":"Oe S, Yamato Y, Hasegawa T,  The relationship between frailty and spinal alignment in the elderly general population: a two-year longitudinal study. Eur Spine J. 2023;32(7):2266\u20132273."},{"issue":"3","key":"b18","series-title":"Neurosurgery","first-page":"552","article-title":"Impact of frailty on outcomes following spine surgery: a prospective cohort analysis of 668 patients","volume":"88","author":"Agarwal N","year":"2021","unstructured":"Agarwal N, Goldschmidt E, Taylor T,  Impact of frailty on outcomes following spine surgery: a prospective cohort analysis of 668 patients. Neurosurgery. 2021;88(3):552\u2013557."},{"issue":"6","key":"b19","series-title":"J Neurosurg Spine","first-page":"667","article-title":"Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors","volume":"15","author":"Acosta FL Jr","year":"2011","unstructured":"Acosta FL Jr, McClendon J Jr, O\u2019Shaughnessy BA,  Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine. 2011;15(6):667\u2013674."},{"issue":"4","key":"b20","series-title":"Spine J","first-page":"582","article-title":"The frailty-driven predictive model for failure to rescue among patients who experienced a major complication following cervical decompression and fusion: an ACS-NSQIP analysis of 3,632 cases (2011\u20132020)","volume":"24","author":"Rumalla KC","year":"2024","unstructured":"Rumalla KC, Covell MM, Skandalakis GP,  The frailty-driven predictive model for failure to rescue among patients who experienced a major complication following cervical decompression and fusion: an ACS-NSQIP analysis of 3,632 cases (2011\u20132020). Spine J. 2024;24(4):582\u2013589."},{"key":"b21","series-title":"Neurosurgery","article-title":"Elderly patients show substantial improvement in health-related quality of life after surgery for degenerative cervical myelopathy despite medical frailty: an ambispective analysis of a multicenter, international data set","author":"Pedro KM","unstructured":"Pedro KM, Alvi MA, Hejrati N, Moghaddamjou A, Fehlings MG. Elderly patients show substantial improvement in health-related quality of life after surgery for degenerative cervical myelopathy despite medical frailty: an ambispective analysis of a multicenter, international data set. Neurosurgery. Published online January 10, 2024. doi:10.1227\/neu.0000000000002818"},{"issue":"8","key":"b22","series-title":"Qual Life Res","first-page":"2041","article-title":"Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis","volume":"28","author":"Crocker TF","year":"2019","unstructured":"Crocker TF, Brown L, Clegg A,  Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. 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Neurosurgery. 2021;88(2):420\u2013427."},{"issue":"1","key":"b25","series-title":"BMC Geriatr","first-page":"771","article-title":"Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis","volume":"23","author":"Baek W","year":"2023","unstructured":"Baek W, Park SY, Kim Y. Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis. BMC Geriatr. 2023;23(1):771."},{"issue":"4","key":"b26","series-title":"Neurospine","first-page":"1337","article-title":"A predictive model of failure to rescue after thoracolumbar fusion","volume":"20","author":"Roy JM","year":"2023","unstructured":"Roy JM, Segura AC, Rumalla K, Skandalakis GP, Covell MM, Bowers CA. A predictive model of failure to rescue after thoracolumbar fusion. Neurospine. 2023;20(4):1337\u20131345."},{"issue":"1","key":"b27","series-title":"J Neurosurg Anesthesiol","first-page":"19","article-title":"Frailty assessment and prehabilitation before complex spine surgery in patients with degenerative spine disease: a narrative review","volume":"35","author":"Mohamed B","year":"2023","unstructured":"Mohamed B, Ramachandran R, Rabai F,  Frailty assessment and prehabilitation before complex spine surgery in patients with degenerative spine disease: a narrative review. J Neurosurg Anesthesiol. 2023;35(1):19\u201330."},{"issue":"2","key":"b28","series-title":"Age Ageing","first-page":"afae011","article-title":"Summary of best evidence for prevention and management of frailty","volume":"53","author":"Guo Y","year":"2024","unstructured":"Guo Y, Miao X, Hu J,  Summary of best evidence for prevention and management of frailty. 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