An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery

Emily K. Miller, Brian J. Neuman, Amit Jain, Alan H. Daniels, Tamir Ailon, Daniel M. Sciubba, Khaled M. Kebaish, Virginie Lafage, Justin K. Scheer, Justin S. Smith, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames, and the International Spine Study Group

Research output: Contribution to journalArticle

Abstract

OBJECTIVE The goal of this study was to analyze the value of an adult spinal deformity frailty index (ASD-FI) in preoperative risk stratification. Preoperative risk assessment is imperative before procedures known to have high complication rates, such as ASD surgery. Frailty has been associated with risk of complications in trauma surgery, and preoperative frailty assessments could improve the accuracy of risk stratification by providing a comprehensive analysis of patient factors that contribute to an increased risk of complications. METHODS Using 40 variables, the authors calculated frailty scores with a validated method for 417 patients (enrolled between 2010 and 2014) with a minimum 2-year follow-up in an ASD database. On the basis of these scores, the authors categorized patients as not frail (NF) ( < 0.3 points), frail (0.3-0.5 points), or severely frail (SF) ( > 0.5 points). The correlation between frailty category and incidence of complications was analyzed. RESULTS The overall mean ASD-FI score was 0.33 (range 0.0-0.8). Compared with NF patients (n = 183), frail patients (n = 158) and SF patients (n = 109) had longer mean hospital stays (1.2 and 1.6 times longer, respectively; p < 0.001). The adjusted odds of experiencing a major intraoperative or postoperative complication were higher for frail patients (OR 2.8) and SF patients ( 4.1) compared with NF patients (p < 0.01). For frail and SF patients, respectively, the adjusted odds of developing proximal junctional kyphosis (OR 2.8 and 3.1) were higher than those for NF patients. The SF patients had higher odds of developing pseudarthrosis (OR 13.0), deep wound infection (OR 8.0), and wound dehiscence (OR 13.4) than NF patients (p < 0.05), and they had 2.1 times greater odds of reoperation (p < 0.05). CONCLUSIONS Greater patient frailty, as measured by the ASD-FI, was associated with worse outcome in many common quality and value metrics, including greater risk of major complications, proximal junctional kyphosis, pseudarthrosis, deep wound infection, wound dehiscence, reoperation, and longer hospital stay.

LanguageEnglish (US)
Article numberE3
JournalNeurosurgical Focus
Volume43
Issue number6
DOIs
StatePublished - Dec 1 2017

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Kyphosis
Pseudarthrosis
Wound Infection
Reoperation
Length of Stay
Wounds and Injuries
Intraoperative Complications
Statistical Factor Analysis
Databases
Incidence

Keywords

  • Adult spinal deformity
  • Complications
  • Frailty index
  • Personalized preoperative risk stratification

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Miller, E. K., Neuman, B. J., Jain, A., Daniels, A. H., Ailon, T., Sciubba, D. M., ... and the International Spine Study Group (2017). An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery. Neurosurgical Focus, 43(6), [E3]. DOI: 10.3171/2017.10.FOCUS17472

An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery. / Miller, Emily K.; Neuman, Brian J.; Jain, Amit; Daniels, Alan H.; Ailon, Tamir; Sciubba, Daniel M.; Kebaish, Khaled M.; Lafage, Virginie; Scheer, Justin K.; Smith, Justin S.; Bess, Shay; Shaffrey, Christopher I.; Ames, Christopher P.; and the International Spine Study Group.

In: Neurosurgical Focus, Vol. 43, No. 6, E3, 01.12.2017.

Research output: Contribution to journalArticle

Miller, EK, Neuman, BJ, Jain, A, Daniels, AH, Ailon, T, Sciubba, DM, Kebaish, KM, Lafage, V, Scheer, JK, Smith, JS, Bess, S, Shaffrey, CI, Ames, CP & and the International Spine Study Group 2017, 'An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery' Neurosurgical Focus, vol 43, no. 6, E3. DOI: 10.3171/2017.10.FOCUS17472
Miller, Emily K. ; Neuman, Brian J. ; Jain, Amit ; Daniels, Alan H. ; Ailon, Tamir ; Sciubba, Daniel M. ; Kebaish, Khaled M. ; Lafage, Virginie ; Scheer, Justin K. ; Smith, Justin S. ; Bess, Shay ; Shaffrey, Christopher I. ; Ames, Christopher P. ; and the International Spine Study Group. / An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery. In: Neurosurgical Focus. 2017 ; Vol. 43, No. 6.
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abstract = "OBJECTIVE The goal of this study was to analyze the value of an adult spinal deformity frailty index (ASD-FI) in preoperative risk stratification. Preoperative risk assessment is imperative before procedures known to have high complication rates, such as ASD surgery. Frailty has been associated with risk of complications in trauma surgery, and preoperative frailty assessments could improve the accuracy of risk stratification by providing a comprehensive analysis of patient factors that contribute to an increased risk of complications. METHODS Using 40 variables, the authors calculated frailty scores with a validated method for 417 patients (enrolled between 2010 and 2014) with a minimum 2-year follow-up in an ASD database. On the basis of these scores, the authors categorized patients as not frail (NF) ( < 0.3 points), frail (0.3-0.5 points), or severely frail (SF) ( > 0.5 points). The correlation between frailty category and incidence of complications was analyzed. RESULTS The overall mean ASD-FI score was 0.33 (range 0.0-0.8). Compared with NF patients (n = 183), frail patients (n = 158) and SF patients (n = 109) had longer mean hospital stays (1.2 and 1.6 times longer, respectively; p < 0.001). The adjusted odds of experiencing a major intraoperative or postoperative complication were higher for frail patients (OR 2.8) and SF patients ( 4.1) compared with NF patients (p < 0.01). For frail and SF patients, respectively, the adjusted odds of developing proximal junctional kyphosis (OR 2.8 and 3.1) were higher than those for NF patients. The SF patients had higher odds of developing pseudarthrosis (OR 13.0), deep wound infection (OR 8.0), and wound dehiscence (OR 13.4) than NF patients (p < 0.05), and they had 2.1 times greater odds of reoperation (p < 0.05). CONCLUSIONS Greater patient frailty, as measured by the ASD-FI, was associated with worse outcome in many common quality and value metrics, including greater risk of major complications, proximal junctional kyphosis, pseudarthrosis, deep wound infection, wound dehiscence, reoperation, and longer hospital stay.",
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AU - Sciubba,Daniel M.

AU - Kebaish,Khaled M.

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N2 - OBJECTIVE The goal of this study was to analyze the value of an adult spinal deformity frailty index (ASD-FI) in preoperative risk stratification. Preoperative risk assessment is imperative before procedures known to have high complication rates, such as ASD surgery. Frailty has been associated with risk of complications in trauma surgery, and preoperative frailty assessments could improve the accuracy of risk stratification by providing a comprehensive analysis of patient factors that contribute to an increased risk of complications. METHODS Using 40 variables, the authors calculated frailty scores with a validated method for 417 patients (enrolled between 2010 and 2014) with a minimum 2-year follow-up in an ASD database. On the basis of these scores, the authors categorized patients as not frail (NF) ( < 0.3 points), frail (0.3-0.5 points), or severely frail (SF) ( > 0.5 points). The correlation between frailty category and incidence of complications was analyzed. RESULTS The overall mean ASD-FI score was 0.33 (range 0.0-0.8). Compared with NF patients (n = 183), frail patients (n = 158) and SF patients (n = 109) had longer mean hospital stays (1.2 and 1.6 times longer, respectively; p < 0.001). The adjusted odds of experiencing a major intraoperative or postoperative complication were higher for frail patients (OR 2.8) and SF patients ( 4.1) compared with NF patients (p < 0.01). For frail and SF patients, respectively, the adjusted odds of developing proximal junctional kyphosis (OR 2.8 and 3.1) were higher than those for NF patients. The SF patients had higher odds of developing pseudarthrosis (OR 13.0), deep wound infection (OR 8.0), and wound dehiscence (OR 13.4) than NF patients (p < 0.05), and they had 2.1 times greater odds of reoperation (p < 0.05). CONCLUSIONS Greater patient frailty, as measured by the ASD-FI, was associated with worse outcome in many common quality and value metrics, including greater risk of major complications, proximal junctional kyphosis, pseudarthrosis, deep wound infection, wound dehiscence, reoperation, and longer hospital stay.

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