Emily K Miller1, Lawrence G Lenke2, Brian J Neuman3, Daniel M Sciubba4, Khaled M Kebaish3, Justin S Smith5, Yong Qiu6, Benny T Dahl7,8, Ferran Pellisé9, Yukihiro Matsuyama10, Leah Y Carreon11, Michael G Fehlings12, Kenneth M Cheung13, Stephen Lewis14, Mark B Dekutoski15, Frank J Schwab16, Oheneba Boachie-Adjei17, Hossein Mehdian18, Shay Bess19, Christopher I Shaffrey5, Christopher P Ames20. 1. Department of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA. 2. Department of Orthopaedic Surgery, Columbia University, New York, NY. 3. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD. 4. Department of Neurosurgery, The Johns Hopkins University, Baltimore, MD. 5. Department of Neurosurgery, University of Virginia, Charlottesville, VA. 6. Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China. 7. Spine Unit, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. 8. Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX. 9. Spine Research Unit, Hospital Vall d'Hebron Institute of Research, Barcelona, Spain. 10. Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan. 11. Norton Leatherman Spine Center, University of Louisville, Louisville, KY. 12. Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, Ontario, Canada. 13. Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, China. 14. Department of Surgery and Spinal Program, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. 15. Department of Orthopaedic Spine Surgery, The CORE Institute, Phoenix, AZ. 16. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. 17. FOCOS Hospital, Pantang West Accra, Ghana. 18. The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK. 19. Department of Orthopaedic Surgery, New York University, New York, NY. 20. Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA.
Abstract
STUDY DESIGN: Analysis of a prospective multicenter database. OBJECTIVE: To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index. SUMMARY OF BACKGROUND DATA: Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery. METHODS: Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3-0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay. RESULTS: The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients. CONCLUSION: Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures. LEVEL OF EVIDENCE: 2.
STUDY DESIGN: Analysis of a prospective multicenter database. OBJECTIVE: To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index. SUMMARY OF BACKGROUND DATA: Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery. METHODS:Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3-0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay. RESULTS: The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients. CONCLUSION: Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures. LEVEL OF EVIDENCE: 2.
Authors: Peter G Passias; Cole A Bortz; Katherine E Pierce; Haddy Alas; Avery Brown; Dennis Vasquez-Montes; Sara Naessig; Waleed Ahmad; Bassel G Diebo; Tina Raman; Themistocles S Protopsaltis; Aaron J Buckland; Michael C Gerling; Renaud Lafage; Virginie Lafage Journal: Int J Spine Surg Date: 2020-12
Authors: Carl Laverdière; Miltiadis Georgiopoulos; Christopher P Ames; Jason Corban; Pouyan Ahangar; Khaled Awadhi; Michael H Weber Journal: Global Spine J Date: 2021-03-26
Authors: Rushikesh S Joshi; Darryl Lau; Justin K Scheer; Miquel Serra-Burriel; Alba Vila-Casademunt; Shay Bess; Justin S Smith; Ferran Pellise; Christopher P Ames Journal: Spine Deform Date: 2021-05-18
Authors: Jamie R F Wilson; Jetan H Badhiwala; Fan Jiang; Jefferson R Wilson; Branko Kopjar; Alexander R Vaccaro; Michael G Fehlings Journal: J Clin Med Date: 2019-10-17 Impact factor: 4.241