Assessment of a Novel Adult Cervical Deformity Frailty Index as a Component of Preoperative Risk Stratification

Emily K. Miller, Tamir Ailon, Brian J. Neuman, Eric O. Klineberg, Gregory M. Mundis, Daniel M. Sciubba, Khaled M. Kebaish, Virginie Lafage, Justin K. Scheer, Justin S. Smith, D. Kojo Hamilton, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames, International Spine Study Group

Research output: Research - peer-reviewArticle

Abstract

Objective To determine the value of a novel adult cervical deformity frailty index (CD-FI) in preoperative risk stratification. Methods We reviewed a prospective, multicenter database of adults with cervical spine deformity. We selected 40 variables to construct the CD-FI using a validated method. Patients were categorized as not frail (NF) (<0.2), frail (0.2–0.4), or severely frail (SF) (>0.4) according to CD-FI score. We performed multivariate logistic regression to determine the relationships between CD-FI score and incidence of complications, length of hospital stay, and discharge disposition. Results Of 61 patients enrolled from 2009 to 2015 with at least 1 year of follow-up, the mean CD-FI score was 0.26 (range 0.25–0.59). Seventeen patients were categorized as NF, 34 as frail, and 10 as SF. The incidence of major complications increased with greater frailty, with a gamma correlation coefficient of 0.25 (asymptotic standard error, 0.22). The odds of having a major complication were greater for frail patients (odds ratio 4.4; 95% confidence interval 0.6–32) and SF patients (odds ratio 43; 95% confidence interval 2.7–684) compared with NF patients. Greater frailty was associated with a greater incidence of medical complications and had a gamma correlation coefficient of 0.30 (asymptotic standard error, 0.26). Surgical complications, discharge disposition, and length of hospital stay did not correlate significantly with frailty. Conclusions Greater frailty was associated with greater risk of major complications for patients undergoing cervical spine deformity surgery. The CD-FI may be used to improve the accuracy of preoperative risk stratification and allow for adequate patient counseling.

LanguageEnglish (US)
Pagese800-e806
JournalWorld Neurosurgery
Volume109
DOIs
StatePublished - Jan 1 2018

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Length of Stay
Incidence
Spine
Odds Ratio
Confidence Intervals
Counseling
Logistic Models
Databases

Keywords

  • Adult spinal deformity surgery
  • Cervical spine
  • Complications
  • Frailty
  • Individualization
  • Risk stratification

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Miller, E. K., Ailon, T., Neuman, B. J., Klineberg, E. O., Mundis, G. M., Sciubba, D. M., ... International Spine Study Group (2018). Assessment of a Novel Adult Cervical Deformity Frailty Index as a Component of Preoperative Risk Stratification. World Neurosurgery, 109, e800-e806. DOI: 10.1016/j.wneu.2017.10.092

Assessment of a Novel Adult Cervical Deformity Frailty Index as a Component of Preoperative Risk Stratification. / Miller, Emily K.; Ailon, Tamir; Neuman, Brian J.; Klineberg, Eric O.; Mundis, Gregory M.; Sciubba, Daniel M.; Kebaish, Khaled M.; Lafage, Virginie; Scheer, Justin K.; Smith, Justin S.; Hamilton, D. Kojo; Bess, Shay; Shaffrey, Christopher I.; Ames, Christopher P.; International Spine Study Group.

In: World Neurosurgery, Vol. 109, 01.01.2018, p. e800-e806.

Research output: Research - peer-reviewArticle

Miller, EK, Ailon, T, Neuman, BJ, Klineberg, EO, Mundis, GM, Sciubba, DM, Kebaish, KM, Lafage, V, Scheer, JK, Smith, JS, Hamilton, DK, Bess, S, Shaffrey, CI, Ames, CP & International Spine Study Group 2018, 'Assessment of a Novel Adult Cervical Deformity Frailty Index as a Component of Preoperative Risk Stratification' World Neurosurgery, vol 109, pp. e800-e806. DOI: 10.1016/j.wneu.2017.10.092
Miller, Emily K. ; Ailon, Tamir ; Neuman, Brian J. ; Klineberg, Eric O. ; Mundis, Gregory M. ; Sciubba, Daniel M. ; Kebaish, Khaled M. ; Lafage, Virginie ; Scheer, Justin K. ; Smith, Justin S. ; Hamilton, D. Kojo ; Bess, Shay ; Shaffrey, Christopher I. ; Ames, Christopher P. ; International Spine Study Group. / Assessment of a Novel Adult Cervical Deformity Frailty Index as a Component of Preoperative Risk Stratification. In: World Neurosurgery. 2018 ; Vol. 109. pp. e800-e806
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abstract = "Objective To determine the value of a novel adult cervical deformity frailty index (CD-FI) in preoperative risk stratification. Methods We reviewed a prospective, multicenter database of adults with cervical spine deformity. We selected 40 variables to construct the CD-FI using a validated method. Patients were categorized as not frail (NF) (<0.2), frail (0.2–0.4), or severely frail (SF) (>0.4) according to CD-FI score. We performed multivariate logistic regression to determine the relationships between CD-FI score and incidence of complications, length of hospital stay, and discharge disposition. Results Of 61 patients enrolled from 2009 to 2015 with at least 1 year of follow-up, the mean CD-FI score was 0.26 (range 0.25–0.59). Seventeen patients were categorized as NF, 34 as frail, and 10 as SF. The incidence of major complications increased with greater frailty, with a gamma correlation coefficient of 0.25 (asymptotic standard error, 0.22). The odds of having a major complication were greater for frail patients (odds ratio 4.4; 95% confidence interval 0.6–32) and SF patients (odds ratio 43; 95% confidence interval 2.7–684) compared with NF patients. Greater frailty was associated with a greater incidence of medical complications and had a gamma correlation coefficient of 0.30 (asymptotic standard error, 0.26). Surgical complications, discharge disposition, and length of hospital stay did not correlate significantly with frailty. Conclusions Greater frailty was associated with greater risk of major complications for patients undergoing cervical spine deformity surgery. The CD-FI may be used to improve the accuracy of preoperative risk stratification and allow for adequate patient counseling.",
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AU - Miller,Emily K.

AU - Ailon,Tamir

AU - Neuman,Brian J.

AU - Klineberg,Eric O.

AU - Mundis,Gregory M.

AU - Sciubba,Daniel M.

AU - Kebaish,Khaled M.

AU - Lafage,Virginie

AU - Scheer,Justin K.

AU - Smith,Justin S.

AU - Hamilton,D. Kojo

AU - Bess,Shay

AU - Shaffrey,Christopher I.

AU - Ames,Christopher P.

AU - International Spine Study Group

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N2 - Objective To determine the value of a novel adult cervical deformity frailty index (CD-FI) in preoperative risk stratification. Methods We reviewed a prospective, multicenter database of adults with cervical spine deformity. We selected 40 variables to construct the CD-FI using a validated method. Patients were categorized as not frail (NF) (<0.2), frail (0.2–0.4), or severely frail (SF) (>0.4) according to CD-FI score. We performed multivariate logistic regression to determine the relationships between CD-FI score and incidence of complications, length of hospital stay, and discharge disposition. Results Of 61 patients enrolled from 2009 to 2015 with at least 1 year of follow-up, the mean CD-FI score was 0.26 (range 0.25–0.59). Seventeen patients were categorized as NF, 34 as frail, and 10 as SF. The incidence of major complications increased with greater frailty, with a gamma correlation coefficient of 0.25 (asymptotic standard error, 0.22). The odds of having a major complication were greater for frail patients (odds ratio 4.4; 95% confidence interval 0.6–32) and SF patients (odds ratio 43; 95% confidence interval 2.7–684) compared with NF patients. Greater frailty was associated with a greater incidence of medical complications and had a gamma correlation coefficient of 0.30 (asymptotic standard error, 0.26). Surgical complications, discharge disposition, and length of hospital stay did not correlate significantly with frailty. Conclusions Greater frailty was associated with greater risk of major complications for patients undergoing cervical spine deformity surgery. The CD-FI may be used to improve the accuracy of preoperative risk stratification and allow for adequate patient counseling.

AB - Objective To determine the value of a novel adult cervical deformity frailty index (CD-FI) in preoperative risk stratification. Methods We reviewed a prospective, multicenter database of adults with cervical spine deformity. We selected 40 variables to construct the CD-FI using a validated method. Patients were categorized as not frail (NF) (<0.2), frail (0.2–0.4), or severely frail (SF) (>0.4) according to CD-FI score. We performed multivariate logistic regression to determine the relationships between CD-FI score and incidence of complications, length of hospital stay, and discharge disposition. Results Of 61 patients enrolled from 2009 to 2015 with at least 1 year of follow-up, the mean CD-FI score was 0.26 (range 0.25–0.59). Seventeen patients were categorized as NF, 34 as frail, and 10 as SF. The incidence of major complications increased with greater frailty, with a gamma correlation coefficient of 0.25 (asymptotic standard error, 0.22). The odds of having a major complication were greater for frail patients (odds ratio 4.4; 95% confidence interval 0.6–32) and SF patients (odds ratio 43; 95% confidence interval 2.7–684) compared with NF patients. Greater frailty was associated with a greater incidence of medical complications and had a gamma correlation coefficient of 0.30 (asymptotic standard error, 0.26). Surgical complications, discharge disposition, and length of hospital stay did not correlate significantly with frailty. Conclusions Greater frailty was associated with greater risk of major complications for patients undergoing cervical spine deformity surgery. The CD-FI may be used to improve the accuracy of preoperative risk stratification and allow for adequate patient counseling.

KW - Adult spinal deformity surgery

KW - Cervical spine

KW - Complications

KW - Frailty

KW - Individualization

KW - Risk stratification

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