Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery

Reid, Daniel; Daniels, Alan H.; Ailon, Tamir; Miller, Emily; Sciubba, Daniel M.; Smith, Justin S.; Shaffrey, Christopher I.; Schwab, Frank J.; Burton, Douglas C.; Hart, Robert A.; Hostin, Richard A.; Line, Breton; Bess, Shay; Ames, Christopher P.

doi:10.1016/j.wneu.2018.01.079

Cited by 78 publications

(81 citation statements)

References 34 publications

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“…The leading frailty indices in the spine literature are as follows: mFI; Adult Spinal Deformity Frailty Index (ASD-FI); and the Cervical Deformity Frailty Index (CD-FI). [32][33][34][35] Although both the frailty index model and frailty phenotype measures have pros and cons, some have concluded that the frailty index model remains the most versatile with wide applicability for both research and clinical use, as it quantifies the concept of frailty. 36,37 Moskven et al 38 identified mFI as the most viable current option for assessing, quantifying, and stratifying the severity of frailty in patients undergoing spine surgery.…”

Section: Discussionmentioning

confidence: 99%

<p>Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery</p>

Sun¹,

Lu²,

Kong³

et al. 2020

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Background and Aim: Frailty is an independent predictor of mortality and adverse events (AEs) in patients undergoing surgery. This study aimed to quantify the ability of Modified Frailty Index (mFI) to predict AEs in older patients undergoing elective posterior thoracolumbar fusion surgery. Methods: We retrospectively reviewed the results of 426 patients with the following diagnoses and follow-up evaluations of at least 12 months duration: lumbar disc herniation, 125; degenerative spondylolisthesis, 81; lumbar spinal canal stenosis, 187; and adult spinal deformities, 33. The cases were divided into two groups. The long spinal fusion (LSF) group was defined as ≥3 spinal levels with segmental pedicle-screw fixation. Short spinal fusion (SSF) were defined with at most two levels. The mFI used in the present study is an 11variable assessment. The association of frailty with AEs was determined after adjusting for known and suspected confounders. Results: Frailty was presented in 66 patients (15.5%) within the total population (LSF, 21.9% and SSF, 11.8%). Rates of AEs assessed in the study increased stepwise with an increase in the mFI for the two groups. The severity of frailty was an independent predictor of any, major, and minor complications in the LSF group and any, minor complication in the SSF group (P<0.05). A comparison of post-operative clinical outcomes showed that the ODI and SF-36 scores deteriorated as the mFI increased. Conclusion: Frailty was shown to be an independent predictor of AEs in older patients undergoing elective posterior thoracolumbar fusion surgery, especially for patients undergoing LSF.

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Section: Discussionmentioning

confidence: 99%

<p>Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery</p>

Sun¹,

Lu²,

Kong³

et al. 2020

CIA

View full text Add to dashboard Cite

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“…The current body of literature predominantly uses the mFI, although recent studies have adopted alternative indices such as the CCI, CD-FI, or ASD-FI [32,34,42,44]. The mFI score evaluation is convenient from medical history, but indices that account for a higher number of variables and comprise relevant laboratory or functional measures have enhanced accuracy in measuring the frailty level.…”

Section: Discussionmentioning

confidence: 99%

“…A study of patients who underwent ASD surgery reported that the proportion of moderately frail patients to reach substantial clinical benefit (SCB) at the 2-year follow-up was higher than that of non-frail patients regarding several health-related quality of life measures, including the Oswestry Disability Index (ODI), the 36-item Short-Form Health Survey Physical Component Summary score, and numeric leg pain. Reportedly, severely frail patients were least likely to reach SCB [34]. Another study of frailty in ASD surgery did not find this correlation; rather the postsurgical ODI scores declined markedly as frailty and comorbidity level increased [44].…”

Section: Frailty and Spine Surgerymentioning

confidence: 99%

Frailty Syndrome and the Use of Frailty Indices as a Preoperative Risk Stratification Tool in Spine Surgery: A Review

et al. 2019

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This comprehensive narrative literature review aims to extract studies related to frailty indices and their use in elective spine procedures, as limited studies regarding frailty exist in the spine literature. Most studies are retrospective analyses of prospectively collected databases. Evidence suggests a positive correlation between frailty level and mortality rate, postoperative complication rate, length of stay, and the possibility of discharge to a skilled nursing facility; these correlations have been illustrated across various spine procedures. The leading index is the modified frailty index, which measures 11 deficits. The development of more comprehensive frailty indices, such as the Adult Spinal Deformity Frailty Index, are promising and have high predictive value regarding postoperative complication rate in patients with spinal deformity. However, a frailty index that combines clinical, radiographic, and laboratory measures awaits development. Perhaps, the use of a frailty index in preoperative risk stratification for elective spine procedures could serve multiple purposes, including screening for high-risk patients, enhancement of operative decision making, approximation of complication rate for informed decision making, and refinement of perioperative care. Further prospective studies are warranted to determine clinically meaningful interventions in frail individuals.

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“…Sagittal imbalance can induce increasing energy expenditure and develop painful compensatory alignment changes [ 36 - 38 ]. There have been some studies about HRQoL related to sagittal malalignment in spinal deformity or related to thoracolumbar or spinopelvic imbalance [ 35 , 39 - 41 ]. In despite of commonly performed multilevel cervical fusion surgery, only a few authors have analyzed HRQoL after cervical kyphosis correction surgery.…”

Section: Methodsmentioning

confidence: 99%

Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review

2020

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When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. These compensations occur through mobile spine segments as well as pelvic tilt and lower extremities. The purpose of this review was to understand the surgical impact on global sagittal alignment and health-related quality of life (HRQoL) following cervical kyphosis correction surgery. The cervical kyphosis correction surgery induces reciprocal changes in craniocervical and thoracolumbar alignment. Successful cervical deformity correction needs to focus not only on restoring proper cervical lordosis, but also on achieving global balance of the cervical spine with other parts of the spine. The goal of the surgery is to achieve occiputtrunk (OT) concordance (the center of gravity-C7 sagittal vertical axis < 30 mm) and cervical sagittal balance. Once OT-concordance is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize global spinal alignment. Reciprocal changes after surgery exhibit different patterns depending on whether patients have compensation ability in their thoracolumbar spine or not. C2-7 sagittal vertical axis and sagittal morphotype of the cervical kyphosis are correlated with HRQoL. Changes in cervical lordosis minus T1 slope correlate to HRQoL improvements.

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Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery

Cited by 78 publications

References 34 publications

<p>Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery</p>

<p>Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery</p>

Frailty Syndrome and the Use of Frailty Indices as a Preoperative Risk Stratification Tool in Spine Surgery: A Review

Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review

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