TY - JOUR
T1 - Performance of the Modified Adult Spinal Deformity Frailty Index in Preoperative Risk Assessment
AU - Passias, Peter G.
AU - Moattari, Kevin
AU - Pierce, Katherine E.
AU - Passfall, Lara
AU - Krol, Oscar
AU - Naessig, Sara
AU - Ahmad, Waleed
AU - Schoenfeld, Andrew J.
AU - Ahmad, Salman
AU - Singh, Vivek
AU - Joujon-Roche, Rachel
AU - Williamson, Tyler K.
AU - Imbo, Bailey
AU - Tretiakov, Peter
AU - Vira, Shaleen
AU - Diebo, Bassel
AU - Lafage, Renaud
AU - Lafage, Virginie
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/10/15
Y1 - 2022/10/15
N2 - Study Design. Retrospective single-center, consecutively enrolled database of adult spinal deformity (ASD) patients. Objective. The aim of this study was to assess the performance of the mASD-FI in predicting clinical and patient-reported outcomes after ASD-corrective surgery. Summary of Background Data. The recently described modified Adult Spinal Deformity frailty index (mASD-FI) quantifies frailty of ASD patients, but the utility of this clinical prediction tool as a means of prognosticating postoperative outcomes has not been investigated. Methods. ASD patients with available mASD-FI scores and HRQL data at presentation and 2-years postop were included. Patients were stratified by mASD-FI score using published cutoffs: not frail (NF <7), frail (F, 7-12), severely frail (SF, >12). Analysis of vaiance assessed differences in patient factors across frailty groups. Linear regression assessed the relationship of mASD-FI with length of stay (LOS) and HRQLs. Multivariable logistic regression revealed how frailty category predicted odds of complications, infections and reoperation. Results. A total of 509 patients included (59 years, 79%F, 27.7 kg/m2). The cohort presented with moderate baseline deformity: sagittal vertical axis (83.7 mm ± 71), PT (12.7° ± 10.8°), PI-LL (43.1° ± 21.1°). Mean preoperative mASD-FI score was 7.2, frailty category: NF (50.3%), F (34.0%), SF (15.7%). Age, BMI, and Charlson Comorbidity Index increased with frailty categories (all P < 0.001); however, fusion length (P = 0.247) and osteotomy rate (P = 0.731) did not. At baseline, increasing frailty was associated with inferior Oswestry Disability Index (ODI), EuroQol 5-Dimension Questionnaire (EQ-5D), SRS-22r, Pain Catastrophizing Scale, and NRS Back and Leg (all P < 0.001). Greater frailty was associated with increased LOS and reduced postoperative HRQL. Controlling for complication incidence, baseline mASD-FI predicted 2 year postop scores for year ODI (b = 0.7, 0.58-0.8, P < 0.001) SRS (b = a '0.023, a '0.03 to a '0.02, P < 0.001), EQ-5D (b = a '0.003, a '0.004 to a '0.002, P < 0.001). F and SF were associated with greater odds of unplanned revision surgery and complications. Conclusion. Higher preoperative mASD-FI score was associated with significantly greater complications, higher rate of unplanned reoperations and lower postoperative HRQL in this investigation. The mASD-FI provides similar prognostic utility while reducing burden for surgeons and patients.
AB - Study Design. Retrospective single-center, consecutively enrolled database of adult spinal deformity (ASD) patients. Objective. The aim of this study was to assess the performance of the mASD-FI in predicting clinical and patient-reported outcomes after ASD-corrective surgery. Summary of Background Data. The recently described modified Adult Spinal Deformity frailty index (mASD-FI) quantifies frailty of ASD patients, but the utility of this clinical prediction tool as a means of prognosticating postoperative outcomes has not been investigated. Methods. ASD patients with available mASD-FI scores and HRQL data at presentation and 2-years postop were included. Patients were stratified by mASD-FI score using published cutoffs: not frail (NF <7), frail (F, 7-12), severely frail (SF, >12). Analysis of vaiance assessed differences in patient factors across frailty groups. Linear regression assessed the relationship of mASD-FI with length of stay (LOS) and HRQLs. Multivariable logistic regression revealed how frailty category predicted odds of complications, infections and reoperation. Results. A total of 509 patients included (59 years, 79%F, 27.7 kg/m2). The cohort presented with moderate baseline deformity: sagittal vertical axis (83.7 mm ± 71), PT (12.7° ± 10.8°), PI-LL (43.1° ± 21.1°). Mean preoperative mASD-FI score was 7.2, frailty category: NF (50.3%), F (34.0%), SF (15.7%). Age, BMI, and Charlson Comorbidity Index increased with frailty categories (all P < 0.001); however, fusion length (P = 0.247) and osteotomy rate (P = 0.731) did not. At baseline, increasing frailty was associated with inferior Oswestry Disability Index (ODI), EuroQol 5-Dimension Questionnaire (EQ-5D), SRS-22r, Pain Catastrophizing Scale, and NRS Back and Leg (all P < 0.001). Greater frailty was associated with increased LOS and reduced postoperative HRQL. Controlling for complication incidence, baseline mASD-FI predicted 2 year postop scores for year ODI (b = 0.7, 0.58-0.8, P < 0.001) SRS (b = a '0.023, a '0.03 to a '0.02, P < 0.001), EQ-5D (b = a '0.003, a '0.004 to a '0.002, P < 0.001). F and SF were associated with greater odds of unplanned revision surgery and complications. Conclusion. Higher preoperative mASD-FI score was associated with significantly greater complications, higher rate of unplanned reoperations and lower postoperative HRQL in this investigation. The mASD-FI provides similar prognostic utility while reducing burden for surgeons and patients.
KW - complications
KW - deformity
KW - frailty
KW - fusion
KW - HRQL
KW - spine.
UR - http://www.scopus.com/inward/record.url?scp=85139068287&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85139068287&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004342
DO - 10.1097/BRS.0000000000004342
M3 - Article
C2 - 35125455
AN - SCOPUS:85139068287
SN - 0362-2436
VL - 47
SP - 1463
EP - 1469
JO - Spine
JF - Spine
IS - 20
ER -