The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery

Beauchamp-Chalifour, Philippe; Flexman, Alana M.; Street, John; Fisher, Charles G.; Ailon, Tamir; Dvorak, Marcel F.; Paquette, Scott; Dea, Nicolas; Charest-Morin, Raphaële

doi:10.3171/2021.2.spine201879

Cited by 13 publications

(9 citation statements)

References 28 publications

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“…In the field of spine surgery, various iterations of frailty, specifically the modified frailty index (mFI), have been effective tools for predicting postoperative adverse surgical events, morbidity, and mortality [8][9][10][11]. However, most of these studies have primarily examined patients undergoing anterior cervical or thoracolumbar procedures.…”

Section: Introductionmentioning

confidence: 99%

Modified Frailty Index as a Predictor of Postoperative Complications and Patient-Reported Outcomes after Posterior Cervical Decompression and Fusion

et al. 2023

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To determine whether the 11-item modified frailty index (mFI) is associated with readmission rates, complication rates, revision rates, or differences in patient-reported outcome measures (PROMs) for patients undergoing posterior cervical decompression and fusion (PCDF). Overview of Literature: mFI incorporates preexisting medical comorbidities and dependency status to determine physiological reserve. Based on previous literature, it may be used as a predictive tool for identifying postoperative clinical and surgical outcomes. Methods: Patients undergoing elective PCDF at our urban academic medical center from 2014 to 2020 were included. Patients were categorized by mFI scores (0-0.08, 0.09-0.17, 0.18-0.26, and ≥0.27). Univariate statistics compared demographics, comorbidities, and clinical/surgical outcomes. Multiple linear regression analysis evaluated the magnitude of improvement in PROMs at 1 year. Results: A total of 165 patients were included and grouped by mFI scores: 0 (n=36), 0.09 (n=62), 0.18 (n=42), and ≥0.27 (n=30). The severe frailty group (mFI ≥0.27) was significantly more likely to be diabetic (p<0.001) and have a greater Elixhauser comorbidity index (p=0.001). They also had worse baseline Physical Component Score-12 (PCS-12) (p=0.011) and modified Japanese Orthopaedic Association (mJOA) (p=0.012) scores and worse 1-year postoperative PCS-12 (p=0.008) and mJOA (p=0.001) scores. On regression analysis, an mFI score of 0.18 was an independent predictor of greater improvement in ∆Visual Analog Scale neck (β=−2.26, p=0.022) and ∆VAS arm (β=−1.76, p=0.042). Regardless of frailty status, patients had similar 90-day readmission rates (p=0.752), complication rates (p=0.223), and revision rates (p=0.814), but patients with severe frailty were more likely to have longer hospital length of stay (p=0.006) and require non-home discharge (p<0.001). Conclusions: Similar improvements across most PROMs can be expected irrespective of the frailty status of patients undergoing PCDF. Complication rates, 90-day readmission rates, and revision rates are not significantly different when stratified by frailty status. However, patients with severe frailty are more likely to have longer hospital stays and require non-home discharge.

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Section: Introductionmentioning

confidence: 99%

Modified Frailty Index as a Predictor of Postoperative Complications and Patient-Reported Outcomes after Posterior Cervical Decompression and Fusion

et al. 2023

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“…Frailty is a syndrome characterized by decreased physiological reserve, daily activities and strength. 10 , 11 Accurate risk stratification and prediction of postoperative complications over time are imperative in older patients undergoing lumbar fusion surgery. 12 Many studies have reported convincing results inn recent years that frailty is a stronger predictor than age for postoperative morbidity.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

Cui¹,

Wang²,

Wang³

et al. 2022

CIA

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Background: There are many studies on the impact of frailty on postoperative complications; however, there are few studies focusing on stepwise propensity score matching (PSM) to offset the influence of age. Methods: We gathered data for patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. According to the Fried frailty phenotype, we categorized patients into non-frail, pre-frail, and frail groups, then, stepwise PSM for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Univariate and multivariate logistic regressions were used to determine the impact of clinical demographics on postoperative complications. Results: A total of 559 consecutive patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PSM, we found that pre-frail patients were more vulnerable to develop urinary retention (p = 0.031) and surgical site infections (p = 0.021) than non-frail patients. Longer length of stay (LOS), delayed ambulation and removal of urinary catheter times were observed in pre-frail patients. However, there was a significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reactive protein (CRP) and frail status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with complications between pre-frail and frail patients. Conclusion: After PSM, we found higher rates of urinary retention and surgical site infections in pre-frail patients than in non-frail patients. CRP was independently related to postoperative complications, while frail status was only independently associated with postoperative complications between pre-frail and non-frail patients. Pre-frail/frail patients tended to have more severe stress responses than non-frail patients.

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“…Frailty is a syndrome of decreased physiological reserve, daily activities as well as strength [10,11].…”

Section: Introductionmentioning

confidence: 99%

The impact of frailty on perioperative outcomes in patients receiving short-level posterior lumbar interbody fusion: a stepwise propensity score matching analysis

Cui

Wang

et al. 2022

Preprint

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Background There were many literatures reporting the impact of frailty on postoperative complications, however, studies according to stepwise propensity score matching (PSM) to offset the influence of age were limited.Methods We gathered data for all patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. Accroding to Fried frailty phenotype, we segragated patients into three groups (not-frailty, pre-frailty, and frailty), then, stepwise propensity score matching for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Uni- and multivariate logistic regression were used to identify the impact of clinical demographics on postoperative complications.Results A total consecutive 559 patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PS matching, we found pre-frail patients were more vulnerable to develop urinary retention ( p = 0.031 ) and surgical site infection ( p = 0.021 ) than non-frail patients. Meanwhile, longer length of stay (LOS), ambulation time and removal of urinary catheter time were observed in pre-frail patients. However, there was significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reaction protein (CRP) and frailty status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with that of between pre-frail and frail patients.Conclusions In this study, after PS matching, we found higher rate of urinary retention and surgical site infection in pre-frail patients than that of non-frail patients. CRP was independently related to postoperative complications, while frailty status was only independently associated with postoperative complications between pre-frail and non-frail patients. And pre-frail/frail patients tended to have severer stress response than that of non-frail patients.

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The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery

Cited by 13 publications

References 28 publications

Modified Frailty Index as a Predictor of Postoperative Complications and Patient-Reported Outcomes after Posterior Cervical Decompression and Fusion

Modified Frailty Index as a Predictor of Postoperative Complications and Patient-Reported Outcomes after Posterior Cervical Decompression and Fusion

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

The impact of frailty on perioperative outcomes in patients receiving short-level posterior lumbar interbody fusion: a stepwise propensity score matching analysis

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