Mitsuru Yagi1,2,3, Takehiro Michikawa4, Naobumi Hosogane3,5, Nobuyuki Fujita1,3, Eijiro Okada1,3, Satoshi Suzuki1,3, Osahiko Tsuji1,3, Narihito Nagoshi1,3, Takashi Asazuma2, Takashi Tsuji3,6, Masaya Nakamura1,3, Morio Matsumoto1,3, Kota Watanabe1,3. 1. Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan. 2. Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan. 3. Keio Spine Research Group, Tokyo, Japan. 4. Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan. 5. Department of Orthopedic Surgery, Kyorin University School of Medicine, Tokyo, Japan. 6. Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan.
Abstract
STUDY DESIGN: A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 ± 19 yrs, 91% female, follow-up 4.3 ± 1.9 yrs) from a multicenter database. OBJECTIVE: To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs). SUMMARY OF BACKGROUND DATA: Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven. METHODS: SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients' frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients. RESULTS: Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to ≥2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3-3.7). CONCLUSION: The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 ± 19 yrs, 91% female, follow-up 4.3 ± 1.9 yrs) from a multicenter database. OBJECTIVE: To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs). SUMMARY OF BACKGROUND DATA: Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven. METHODS:SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients' frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients. RESULTS: Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to ≥2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3-3.7). CONCLUSION: The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients. LEVEL OF EVIDENCE: 4.
Authors: Alexandria F Naftchi; John Vellek; Julia Stack; Eris Spirollari; Sima Vazquez; Ankita Das; Jacob D Greisman; Zehavya Stadlan; Omar H Tarawneh; Sabrina Zeller; Jose F Dominguez; Merritt D Kinon; Chirag D Gandhi; Syed Faraz Kazim; Meic H Schmidt; Christian A Bowers Journal: Dysphagia Date: 2022-08-09 Impact factor: 2.733
Authors: E Quarto; A Zanirato; M Pellegrini; S Vaggi; F Vitali; S Bourret; J C Le Huec; M Formica Journal: Eur Spine J Date: 2022-09-25 Impact factor: 2.721
Authors: Jasmine Lee; Allyson R Alfonso; Rami S Kantar; Gustave K Diep; Zoe P Berman; Elie P Ramly; David A Daar; Jamie P Levine; Daniel J Ceradini Journal: Plast Reconstr Surg Glob Open Date: 2020-07-21
Authors: Daniel R Evans; Eliana B Saltzman; Albert T Anastasio; Ndeye F Guisse; Elshaday S Belay; Tyler S Pidgeon; Marc J Richard; David S Ruch; Oke A Anakwenze; Mark J Gage; Christopher S Klifto Journal: JSES Int Date: 2020-12-16
Authors: Steven A Gordon; Alana Aylward; Neil S Patel; Christian Bowers; Angela P Presson; Ken R Smith; Norman L Foster; Richard K Gurgel Journal: OTO Open Date: 2021-09-24
Authors: Eliana B Saltzman; Daniel R Evans; Albert Anastasio; Ndeye Guisse; Elshaday S Belay; Oke A Anakwenze; Mark J Gage; Tyler S Pidgeon; Marc J Richard; David S Ruch; Christopher S Klifto Journal: JSES Int Date: 2021-09-17
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: Basma Mohamed; Ramani Ramachandran; Ferenc Rabai; Catherine C Price; Adam Polifka; Daniel Hoh; Christoph N Seubert Journal: J Neurosurg Anesthesiol Date: 2021-08-05 Impact factor: 3.956