Prognostic Significance of Baseline Frailty Status in Traumatic Spinal Cord Injury

Abstract

BACKGROUND: Literature evaluating frailty in traumatic spinal cord injury (tSCI) is limited. OBJECTIVE: To evaluate the prognostic significance of baseline frailty status in tSCI. METHODS: Patients with tSCI were identified in the National Inpatient Sample from 2015 to 2018 and stratified according to frailty status, which was quantified using the 11-point modified frailty index (mFI). RESULTS: Among 8825 operatively managed patients with tSCI identified (mean age 57.9 years, 27.6% female), 3125 (35.4%) were robust (mFI = 0), 2530 (28.7%) were prefrail (mFI = 1), 1670 (18.9%) were frail (mFI = 2), and 1500 (17.0%) were severely frail (mFI ≥ 3). One thousand four-hundred forty-five patients (16.4%) were routinely discharged (to home), and 320 (3.6%) died during hospitalization, while 2050 (23.3%) developed a severe complication, and 2175 (24.6%) experienced an extended length of stay. After multivariable analysis adjusting for age, illness severity, trauma burden, and other baseline covariates, frailty (by mFI-11) was independently associated with lower likelihood of routine discharge [adjusted odds ratio (aOR) 0.82, 95% CI 0.77-0.87; P < .001] and development of a severe complication (aOR 1.17, 95% CI 1.12-1.23; P < .001), but not with in-hospital mortality or extended length of stay. Subgroup analysis by age demonstrated robust associations of frailty with routine discharge in advanced age groups (aOR 0.71 in patients 60-80 years and aOR 0.69 in those older than 80 years), which was not present in younger age groups. CONCLUSION: Frailty is an independent predictor of clinical outcomes after tSCI, especially among patients of advanced age. Our large-scale analysis contributes novel insights into limited existing literature on this topic.

Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma

“…We acknowledge that this proposition contrasts with existing trends in the literature citing increased surgical risk associated with advanced age ( Tsujimoto et al, 2022 ; Arul et al, 2019 ). Despite this, there is a growing body of literature endorsing the use of frailty scores as a superior measure of risk stratification and true physiologic status compared to chronological age ( Mehkri et al, 2023 ; Kessler et al, 2018 ; Sun et al, 2020 ; Dicpinigaitis et al, 2022 ).…”

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A simplified frailty index and nomogram to predict the postoperative complications and survival in older patients with upper urinary tract urothelial carcinoma

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