Impact of Frailty on Surgical Outcomes in Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis Publisher Pubmed



Bagherzadeh S ; Roohollahi F ; Rubio DS ; Saleh D ; Greenberg M ; Alikhani P ; Rostami M
Source: European Spine Journal Published:2026

Abstract

Objective: To systematically evaluate the impact of frailty, measured by modified Frailty Indices (mFI) or the Hospital Frailty Risk Score (HFRS), on functional recovery and complication rates following surgical intervention in patients with degenerative cervical myelopathy (DCM). Methods: A systematic search was conducted across PubMed, Embase, Scopus, and Web of Science through July 2025. Studies were included if they reported frailty status and at least one clinical outcome in adult patients undergoing surgery for DCM. Meta-analyses were performed using standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals. Risk of bias was assessed via the Newcastle-Ottawa Scale, and publication bias was evaluated using Egger’s test. Results: Eleven retrospective cohort studies encompassing 105,166 patients were included. High-frailty patients had worse preoperative mJOA (10.83 vs. 12.31), higher Nurick scores (3.97 vs. 3.05), and poorer SF-36 PCS and NDI scores (all p < 0.05). Despite these differences, postoperative improvements were comparable between high- and low-frailty groups across all functional metrics (e.g., ΔmJOA: p = 0.466; ΔNDI: p = 0.794). However, frailty was associated with significantly higher odds of complications, including prolonged hospital stay (SMD 2.25), readmission (OR 2.09), reoperation (OR 4.00), and mortality (OR 11.95). Intraoperative parameters (e.g., blood loss, operative time) did not differ significantly. Conclusions: Frailty is a strong predictor of perioperative risk but does not diminish the potential for functional improvement following DCM surgery. Frailty assessments should inform preoperative counseling, risk stratification, and perioperative optimization strategies rather than exclusion from surgical treatment. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.