Influence of Frailty on Life Expectancy in Octogenarians After Lumbar Spine Surgery

Jang, Hyun‐Jun; Chin, Dong Kyu; Park, Jeong Yoon; Kuh, Sung Uk; Kh, Kim; Cho, Young-Eun; Kim, Kyung-Hyun

doi:10.14245/ns.2040688.344

Cited by 10 publications

(7 citation statements)

References 27 publications

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“…8 Frailty, a measure of physiological reserve, broadly defined as the cumulative burden of baseline comorbid conditions and functional status impairment, has been associated with worse postoperative outcomes across surgical subspecialties. [9][10][11][12][13] In recent years, several studies have assessed the impact of baseline frailty status on postoperative outcomes in patients undergoing spine surgery, 14 though its application to spine trauma and TSI has been limited to 2 studies. 15,16 The lack of large scale, high quality, clinical studies on frailty and spine trauma has been emphasized before.…”

Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

et al. 2022

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Objective: To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs).Methods: The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015–2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes.Results: Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001).Conclusion: Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAI-based frailty indices can be used in preoperative risk assessment of spinal trauma patients.

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Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

et al. 2022

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“…As society ages, spine surgeons increasingly encounter challenging surgeries required for degenerative patients, including revisions and severe scoliosis treatment. Particularly in elderly patients, complications related to screws, such as nerve and vascular injuries, could be life-threatening [ 24 ]. In these circumstances, the need for robot-assisted techniques is warranted.…”

Section: Discussionmentioning

confidence: 99%

A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques

Hwang,

Ha,

Kim

et al. 2024

Neurospine

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Objective: This study aimed to compare the accuracy of robotic spine surgery and conventional pedicle screw fixation in lumbar degenerative disease. We evaluated clinical and radiological outcomes to demonstrate the noninferiority of robotic surgery.Methods: This study employed propensity score matching and included 3 groups: robot-assisted mini-open posterior lumbar interbody fusion (PLIF) (robotic surgery, RS), c-arm guided minimally invasive surgery transforaminal lumbar interbody fusion (C-arm guidance, CG), and freehand open PLIF (free of guidance, FG) (54 patients each). The mean follow-up period was 2.2 years. The preoperative spine condition was considered. Accuracy was evaluated using the Gertzbein-Robbins scale (GRS score) and Babu classification (Babu score). Radiological outcomes included adjacent segmental disease (ASD) and mechanical failure. Clinical outcomes were assessed based on the visual analogue scale, Oswestry Disability Index, 36-item Short Form health survey, and clinical ASD rate.Results: Accuracy was higher in the RS group (p < 0.01) than in other groups. The GRS score was lower in the CG group, whereas the Babu score was lower in the FG group compared with the RS group. No significant differences were observed in radiological and clinical outcomes among the 3 groups. Regression analysis identified preoperative facet degeneration, GRS and Babu scores as significant variables for radiological and clinical ASD. Mechanical failure was influenced by the GRS score and patients’ age.Conclusion: This study showed the superior accuracy of robotic spine surgery compared with conventional techniques. When combined with minimally invasive surgery, robotic surgery is advantageous with reduced ligament and muscle damage associated with traditional open procedures.

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“…Previous evidence has indicated that higher levels of frailty correlate independently with mortality, postoperative complications, prolonged hospital LOS, and discharge to a rehabilitation facility in surgery of elderly populations [ 1 , 17 , 20 , 22 , 23 , 26 , 35 , 38 ]. Our study showed that postoperative complications were significantly associated with frailty measured by the K-FRAIL scale.…”

Section: Discussionmentioning

confidence: 99%

“…Fusion surgery leads to more complications than decompression surgery due to increased blood loss, longer operation time, and higher infection rate [ 20 , 22 ]. Dagistan et al [ 12 ] concluded that increased operative times and instrumentation and fusion procedures were strongly associated with an increased risk of developing complications.…”

Section: Discussionmentioning

confidence: 99%

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Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

Kim

Park

Lee

et al. 2021

J Korean Neurosurg Soc

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Objective : People are living longer and the elderly population continues to increase. The incidence of degenerative spinal diseases (DSDs) in the elderly population is quite high. Therefore, we are facing more cases of DSD and offering more surgical solutions in geriatric patients. Understanding the significance and association of frailty and central sarcopenia as risk factors for spinal surgery in elderly patients will be helpful in improving surgical outcomes. We conducted a retrospective cohort analysis of prospectively collected data to assess the impact of preoperative central sarcopenia, frailty, and comorbidity on surgical outcome in elderly patients with DSD. Methods : We conducted a retrospective analysis of patients who underwent elective spinal surgery performed from January 1, 2019 to September 30, 2020 at our hospital. We included patients aged 65 and over who underwent surgery on the thoracic or lumbar spine and were diagnosed as DSD. Central sarcopenia was measured by the 50th percentile of psoas : L4 vertebral index (PLVI) using the cross-sectional area of the psoas muscle. We used the Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale to measure frailty. Comorbidity was confirmed and scored using the Charlson Comorbidity Index (CCI). As a tool for measuring surgical outcome, we used the Clavien-Dindo (CD) classification for postoperative complications and the length of stay (LOS). Results : This study included 85 patients (35 males and 50 females). The mean age was 74.05±6.47 years. Using the K-FRAIL scale, four patients were scored as robust, 44 patients were pre-frail and 37 patients were frail. The mean PLVI was 0.61±0.19. According to the CD classification, 50 patients were classified as grade 1, 19 as grade 2, and four as grade 4. The mean LOS was 12.35±8.17 days. Multivariate stepwise regression analysis showed that postoperative complication was significantly associated with surgical invasiveness and K-FRAIL scale. LOS was significantly associated with surgical invasiveness and CCI. K-FRAIL scale showed a significant correlation with CCI and PLVI. Conclusion :The present study demonstrates that frailty, comorbidity, and surgical invasiveness are important risk factors for postoperative complications and LOS in elderly patients with DSD. Preoperative recognition of these factors may be useful for perioperative optimization, risk stratification, and patient counseling.

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Influence of Frailty on Life Expectancy in Octogenarians After Lumbar Spine Surgery

Cited by 10 publications

References 27 publications

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury

A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques

Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease

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