TY - JOUR
T1 - Predicting Short-Term Outcome After Surgery for Primary Spinal Tumors Based on Patient Frailty
AU - Ahmed, A. Karim
AU - Goodwin, C. Rory
AU - De la Garza-Ramos, Rafael
AU - Kim, Rachel C.
AU - Abu-Bonsrah, Nancy
AU - Xu, Risheng
AU - Sciubba, Daniel M.
N1 - Funding Information:
Conflict of interest statement: A.K.A. is a Neurosurgery Research & Education Foundation Medical Student Summer Research Fellow. C.R.G. is a UNCF Merck Postdoctoral Fellow and has received an award from the Burroughs Wellcome Fund and the Johns Hopkins Neurosurgery Pain Research Institute. D.M.S. has consulting relationships with Medtronic, Globus, DePuy, and Orthofix. The remaining authors have no conflicts or disclosures.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/12
Y1 - 2017/12
N2 - Objective Frailty, decreased physiologic reserve and increased vulnerability to stressors beyond what is expected for normal aging, is associated with increased risk of morbidity and mortality. The objective of this study was to develop a preoperative frailty index for patients undergoing surgery for primary spinal column tumors that predicts morbidity, mortality, and length of stay. Methods The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients who underwent surgery for a primary spinal tumor. The spinal tumor frailty index, consisting of 9 items, was applied to each patient. Patients were characterized as “not frail” (0), “mildly frail” (1), “moderately frail” (2), and “severely frail” (≥3). Results Inclusion criteria were met by 1589 patients. Overall major complication rate was 10.6%. Compared with patients without frailty, patients with mild (odds ratio 3.83; 95% confidence interval, 2.63–5.58), moderate (odds ratio 6.80; 95% confidence interval, 4.10–11.3), and severe frailty (odds ratio 13.05; 95% confidence interval, 6.34–26.87) had significantly increased odds of developing complications (all P < 0.001). Mean length of stay was 6.4 days ± 0.2, 9.8 days ± 0.6, 14.4 days ± 1.7, and 18.3 days ± 2.6 for patients without frailty, with mild frailty, with moderate frailty, and with severe frailty (P < 0.05 between all groups). Conclusions Compared with patients without frailty, patients with mild, moderate, and severe frailty had significantly increased odds of developing postoperative complications. Systematic evaluation of preoperative frailty should play a key role in decision making for patients undergoing surgery for primary spinal tumors.
AB - Objective Frailty, decreased physiologic reserve and increased vulnerability to stressors beyond what is expected for normal aging, is associated with increased risk of morbidity and mortality. The objective of this study was to develop a preoperative frailty index for patients undergoing surgery for primary spinal column tumors that predicts morbidity, mortality, and length of stay. Methods The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients who underwent surgery for a primary spinal tumor. The spinal tumor frailty index, consisting of 9 items, was applied to each patient. Patients were characterized as “not frail” (0), “mildly frail” (1), “moderately frail” (2), and “severely frail” (≥3). Results Inclusion criteria were met by 1589 patients. Overall major complication rate was 10.6%. Compared with patients without frailty, patients with mild (odds ratio 3.83; 95% confidence interval, 2.63–5.58), moderate (odds ratio 6.80; 95% confidence interval, 4.10–11.3), and severe frailty (odds ratio 13.05; 95% confidence interval, 6.34–26.87) had significantly increased odds of developing complications (all P < 0.001). Mean length of stay was 6.4 days ± 0.2, 9.8 days ± 0.6, 14.4 days ± 1.7, and 18.3 days ± 2.6 for patients without frailty, with mild frailty, with moderate frailty, and with severe frailty (P < 0.05 between all groups). Conclusions Compared with patients without frailty, patients with mild, moderate, and severe frailty had significantly increased odds of developing postoperative complications. Systematic evaluation of preoperative frailty should play a key role in decision making for patients undergoing surgery for primary spinal tumors.
KW - Frailty
KW - Frailty index
KW - Spinal tumor
KW - Spine surgery
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U2 - 10.1016/j.wneu.2017.09.034
DO - 10.1016/j.wneu.2017.09.034
M3 - Article
C2 - 28919566
AN - SCOPUS:85030179336
SN - 1878-8750
VL - 108
SP - 393
EP - 398
JO - World neurosurgery
JF - World neurosurgery
ER -