Correlation Between Preoperative Frailty Index and Functional Recovery After Lumbar Decompression Surgery in Elderly Patients
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Background: Elderly patients undergoing lumbar decompression surgery show variable postoperative recovery, and chronological age alone may not adequately predict functional outcome. Frailty reflects reduced physiological reserve and may provide better risk stratification before surgery. Objective: To determine the association between preoperative frailty and postoperative functional recovery in elderly patients undergoing lumbar decompression surgery and to compare the predictive value of frailty with chronological age. Methods: This prospective cohort study included 170 patients aged 60 years or older undergoing lumbar decompression for lumbar spinal stenosis or low-grade spondylolisthesis. Frailty was assessed preoperatively using the Modified Frailty Index. Functional outcomes were measured using the Oswestry Disability Index, Visual Analog Scale pain score, walking distance, complications, and hospital stay at 1, 3, and 6 months. Multivariate logistic regression and ROC analysis were performed. Results: Patients were classified as non-frail (35%), pre-frail (46%), and frail (19%). Frail patients had higher complication rates than pre-frail and non-frail patients (25% vs 12% vs 7%, p<0.01) and longer hospital stay. At six months, ODI reduction was greatest in non-frail patients and lowest in frail patients (34.5 ± 8.7 vs 18.7 ± 7.9 points, p<0.001). Frailty independently predicted poor recovery (OR 3.5, 95% CI 1.8–6.8, p<0.001), whereas age was not significant. Conclusion: Preoperative frailty is a stronger predictor of postoperative recovery than chronological age and should be integrated into surgical assessment and counseling.
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