Predictive Value of Comprehensive Geriatric Assessment on Early Postoperative Complications Following Lumbar Spinal Stenosis Surgery

Abstract

Study Design. Prospective cohort study. Objective. The aim of this study was to evaluate the predictive value of comprehensive geriatric assessment (CGA) for early postoperative complications in elderly patients (aged 65 years or older) following lumbar spinal stenosis surgery. Summary of Background Data. CGA is a multidisciplinary evaluation modality proven to be effective in various fields of geriatrics. However, limited evidence exists on the effectiveness of CGA in lumbar spinal stenosis patients in the literature. Methods. We prospectively enrolled consecutive patients who were at least 65 years’ old and were scheduled to undergo elective surgery for lumbar spinal stenosis. One day before the operation, multidomain CGA was performed on the patient's functional status, comorbidities, nutrition, cognition, and psychological status. Patients with deficits in three or more CGA domains were defined as frail. The occurrence of postoperative complications (Clavien and Dindo grade 2 or higher) within 30 days after the surgery was assessed as the outcome. The predictive value of CGA was evaluated using crosstab and logistic regression analysis and compared to that of other risk stratification systems, including modified Frailty Index-5, -11, and American Society of Anesthesiologists Physical Classification System. Results. A total of 261 patients were included in the study, and 25 (9.6%) patients were assigned to the “frail” group. There were 27 (10.3%) patients with a postoperative complication (general: n = 20, 7.7%, surgical: n = 7, 2.7%) within postoperative 30 days. Patients with a complication showed significantly more deficits on preoperative CGA than those without complications (P = 0.004). On multivariate logistic regression analysis, frailty based on CGA (odds ratio = 3.51, P = 0.031) and the modified Frailty Index-11 (odds ratio = 3.13, P = 0.038) were associated with the occurrence of general complications. Conclusion. Frailty based on CGA was significantly associated with early general complications following surgery for lumbar spinal stenosis in patients older than 65 years. Level of Evidence: 2

Use of the comprehensive geriatric assessment for the prediction of postoperative complications in elderly patients with head and neck cancer

“…In addition, the number of deficit domains in CGA before treatment and the quality of life were correlated 40 . Several previous studies have reported that the cumulative number of deficits in CGA is an independent predictor of surgical outcomes in elderly patients undergoing elective surgery 8,9 . In a previous study, which is consistent with our study, the presence of two or more deficits in the preoperative CGA was associated with major postoperative complications in elderly patients who underwent colorectal cancer surgery 7 …”

“…However, in this study, all the elderly patients were classified as ASA II or III, and the ASA classification did not show any significant association with major postoperative complications. Similar results were also observed in previous studies on elderly patients who underwent surgery for either spinal stenosis or colon cancer 8,44 . ASA class II includes mild to moderate systemic disease, and ASA class III includes a severe disease process that limits activity 45 .…”

“…Several previous studies have evaluated the usefulness of CGA in predicting surgical outcomes in elderly patients who underwent abdominal, thoracic, or spinal surgery 7–9 . However, the usefulness of CGA in predicting the occurrence of postoperative complications in elderly patients with head and neck cancer has not yet been demonstrated.…”

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

“…Frailty is characterized by physiological age-related decreases in energy, cognitive function, physical health, and other deficits that collectively make the patient more vulnerable to stressors, resulting in adverse outcomes [ 4 , 6 , 17 ]. Consensus on how best to define and measure frailty remains elusive [ 1 , 2 , 5 ]. Frailty has been measured using different methods in the literature.…”

Which frailty scales for patients with adult spinal deformity are feasible and adequate? A systematic review

“…The efficacy of CGA in improving surgical outcomes has been proven by RCTs in other medical domains [120,121]. Chang et al [76] developed CGA for surgical spine patients. The scale covers most comprehensively the concept of frailty and showed significant correlation with postoperative complications in a prospective cohort [76].…”