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Review
. 2025 Mar;15(2):1338-1355.
doi: 10.1177/21925682241235605. Epub 2024 Feb 21.

Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature

Marco Manzetti  1   2 , Alberto Ruffilli  1   2 , Giovanni Viroli  1   2 , Matteo Traversari  1 , Marco Ialuna  1 , Francesca Salamanna  3 , Simona Neri  4 , Cesare Faldini  1   2
Affiliations
Review

Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature

Marco Manzetti et al. Global Spine J. 2025 Mar.

Abstract

Study design: Metanalysis.

Objective: Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI.

Methods: Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant.

Results: 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11).

Conclusion: This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.

Keywords: deformity; degenerative spine; frailty; frailty index; infection; spine surgery.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Prisma flow diagram of the included studies.
Figure 2.
Figure 2.
QUIPS Plot of the included studies.
Figure 3.
Figure 3.
QUIPS plot summary.
Figure 4.
Figure 4.
Forrest plot representation of the metanalysis for mFI-5.
Figure 5.
Figure 5.
Forrest plot representation of the metanalysis for mFI-11.
See this image and copyright information in PMC

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