Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease

Flexman, Alana M.; Charest-Morin, Raphaële; Stobart, Liam; Street, John; Ryerson, Christopher J.

doi:10.1016/j.spinee.2016.06.017

Cited by 147 publications

(133 citation statements)

References 28 publications

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“…38,39 Flexman and associates showed higher complication rates, specifically with infection, in a population of elective degenerative spine patients. 33 Ali and co-workers reviewed the 18,294 patients in the National Surgery Quality Improvement Program (NSQIP) database who had undergone spine surgery. 40 Similar to our own work, this group divided the mFI into low (<2.7) and high ( ‡2.7) categories, and noted a substantial difference in infection (1.7% vs. 4.1%) and mortality (0.1% vs. 2.3%) rates.…”

Section: Discussionmentioning

confidence: 99%

“…Previous authors have subdivided patients into not frail (mFI = 0), pre-frail (0 <mFI <0.21), and frail (mFI ‡0.21) categories. 33 A similar division was made for our tSCI cohort, and association with outcome measures was explored.…”

Section: Frailty On Post-operative Outcomes: Multi-variable Analysismentioning

confidence: 99%

“…11,12 In a recent systematic review of the spine surgery literature, frailty has been demonstrated to affect post-operative outcomes such as adverse events (AEs), mortality, and length of stay (LOS). 13 Although the concept of frailty has been largely accepted, its operational definition is less clear. In most of the spinal literature, the Modified Frailty Index (mFI) has been used as a surrogate measure of frailty.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

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Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were identified from our prospectively collected database from 2004 to 2016. We examined effect of patient age, admission Total Motor Score (TMS), and Modified Frailty Index (mFI) on adverse events (AEs), acute length of stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for three age groups: <60, 61-75, and 76+ years), and multi-variable analysis was performed to investigate the impact of age, TMS, and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS ( p = 0.0375), but not of AEs ( p = 0.1428) or in-hospital mortality ( p = 0.1245). In patients <60 years of age, mFI predicted number of AEs, acute LOS, and in-hospital mortality. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years of age, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcomes in those <75 years of age only. The inter-relationship of advanced age and decreased physiological reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger patients with tSCI may be useful for peri-operative optimization, risk stratification, and patient counseling.

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Section: Discussionmentioning

confidence: 99%

Section: Frailty On Post-operative Outcomes: Multi-variable Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Banaszek

Inglis

Marion

et al. 2020

Journal of Neurotrauma

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“…In prior studies, sarcopenia has been evaluated in a practical fashion by measuring the total area of the psoas muscle on axial computed tomography (CT) scanning although consensus on the appropriate threshold is lacking. Frailty has been shown to predict adverse outcomes in multiple spinal surgical populations [18,19,21,31,32]. In the metastatic spine disease population, frailty and sarcopenia may be potentially useful tools to guide surgical candidacy, urgency and planning, yet, their usefulness to predict mortality and AEs remains unknown in this challenging population.…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Bourassa-Moreau

Versteeg²,

Moskven

et al. 2020

The Spine Journal

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“…Flexman et al, in their review of patients undergoing surgery for degenerative spine disease, concurred. 17 With a growing elderly population, the assessment of frailty in the decision-making process of spinal surgery is imperative. A high frailty index has been correlated with an increased risk of complications and an increased hospital LOS postoperatively.…”

Section: Age/frailtymentioning

confidence: 99%

Development and implementation of a comprehensive spine surgery enhanced recovery after surgery protocol: the Cleveland Clinic experience

Chakravarthy¹,

Yokoi

Coughlin³

et al. 2019

Neurosurgical Focus

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Enhanced recovery after surgery (ERAS) protocols have been shown to be effective at reducing perioperative morbidity and costs while improving outcomes. To date, spine surgery protocols have been limited in scope, focusing only on specific types of procedures or specific parts of the surgical episode. The authors describe the creation and implementation of one of the first comprehensive ERAS protocols for spine surgery. The protocol is unique in that it has a comprehensive perioperative paradigm encompassing the entire surgical period that is tailored based on the complexity of each individual spine patient.

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Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease

Cited by 147 publications

References 28 publications

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine

Development and implementation of a comprehensive spine surgery enhanced recovery after surgery protocol: the Cleveland Clinic experience

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