Publication Date

Spring 2026

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Wei-Chen Tung

Keywords

Frailty, spinal fusion, older adults, preoperative, postoperative

Abstract

Many older adults over the age of 65 have both spinal stenosis requiring spinal fusion surgery and frailty. As life expectancy has increased, many older individuals will undergo elective spinal fusion surgery to decrease their chronic pain in pursuit of improved quality of life. There is currently an underutilization of frailty screening for risk stratification of postoperative complications. A retrospective chart review over a two-year period from July 2023 to June 2025of adults aged 65 and older who underwent posterior spinal fusion surgery, involving 126 participants, was completed. We assessed the correlation between frailty and postoperative outcomes, discharge disposition, and hospital length of stay. The participant’s frailty score was calculated using the 5-factor modified Frailty Index (mFI-5) to assign to one of two frailty cohorts: no frailty (mFI = 0) and frailty (mFI ³ 1). Participant demographics and other surgical defining characteristics were also collected. Data analysis was completed using descriptive statistics, logistic regression, Mann-Whitney U test, Pearson’s chi-square, and Spearman’s correlation coefficient. Frailty was associated with higher odds of developing postoperative complications and discharging to a non-home setting postoperatively. Hospital length of stay was correlated with the number of spinal levels operated on, suggesting it is driven by surgical complexity. Thus, nurse practitioners should implement frailty screening as part of routine preoperative assessment to formulate an individualized plan for each patient to optimize postoperative outcomes, including prehabilitation and early collaboration with case management​ as needed.

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