Response to Letter to the Editor Regarding “High Modified 5 Factor Frailty Index is Associated With Worse PROMs and Decreased Return to Activities After 1 or 2 Level MI-TLIF”
Tejas Subramanian, Sravisht Iyer · 2026
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Description
Tejas Subramanian and Sravisht Iyer reply to a letter criticizing their study of frailty and outcomes after minimally invasive spine surgery in 2026 correspondence. Their work linked a high score on the five-item modified frailty index to worse outcomes and lower return to activities after one- or two-level fusion surgery. The letter writers raised concerns, and this response answers them point by point.
The authors accept several limits, including the small number of frail patients and bias in which patients received follow-up CT scans, and agree prospective studies are needed. They note the link between frailty and outcomes grew stronger across frailty levels, a dose-response pattern supporting the finding. Suggestions to model the index continuously, use time-to-event methods, and test removing one index item are welcomed as extensions. Confounders such as bone density and opioid dose matter but were not the study's target.
Catalog record
| CREATOR | Tejas Subramanian, Sravisht Iyer |
|---|---|
| YEAR | 2026 |
| COLLECTION | PAPERS |
| FORMAT | TXT |
| FILE SIZE | 4 KB |
| VERSION | 1.0 |
| LICENSE | CC BY 4.0 |
| RIGHTS | CC BY |
| SOURCE | Europe PMC |