BACKGROUND: The Miller et al adult spinal deformity frailty index (ASD-FI) correlates with complication risk; however, its development was not rooted in clinical outcomes, and the 40 factors needed for its calculation limit the index's clinical utility. The present study aimed to develop a simplified, weighted frailty index for ASD patients METHODS: This study is a retrospective review of a single-center database. Component ASD-FI parameters contributing to overall ASD-FI score were assessed via Pearson correlation. Top significant, clinically relevant factors were regressed against ASD-FI score to generate the modified ASD-FI (mASD-FI). Component mASD-FI factors were regressed against incidence of medical complications, and factor weights were calculated from regression of these coefficients. Total mASD-FI score ranged from 0 to 21, and was calculated by summing weights of expressed parameters. Linear regression and published ASD-FI cutoffs generated corresponding mASD-FI frailty cutoffs: not frail (NF, <7), frail (7-12), severely frail (SF, >12). Analysis of variance assessed the relationship between frailty category and validated baseline measures of pain and disability at baseline. RESULTS: The study included 50 ASD patients. Eight factors were included in the mASD-FI. Overall mean mASD-FI score was 5.7 ± 5.2. Combined, factors comprising the mASD-FI showed a trend of predicting the incidence of medical complications (Nagelkerke R 2 = 0.558; Cox & Snell R 2 = 0.399; P = .065). Breakdown by frailty category is NF (70%), frail (12%), and SF (18%). Increasing frailty category was associated with significant impairments in measures of pain and disability: Oswestry Disability Index (NF: 23.4; frail: 45.0; SF: 49.3; P < .001), SRS-22r (NF: 3.5; frail: 2.6; SF: 2.4; P = .001), Pain Catastrophizing Scale (NF: 41.9; frail: 32.4; SF: 27.6; P < .001), and NRS Leg Pain (NF: 2.3; frail: 7.2; SF: 5.6; P = .001). CONCLUSIONS: This study modifies an existing ASD frailty index and proposes a weighted, shorter mASD-FI. The mASD-FI relies less on patient-reported variables, and it weights component factors by their contribution to adverse outcomes. Because increasing mASD-FI score is associated with inferior clinical measures of pain and disability, the mASD-FI may serve as a valuable tool for preoperative risk assessment. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
BACKGROUND: The Miller et al adult spinal deformity frailty index (ASD-FI) correlates with complication risk; however, its development was not rooted in clinical outcomes, and the 40 factors needed for its calculation limit the index's clinical utility. The present study aimed to develop a simplified, weighted frailty index for ASD patients METHODS: This study is a retrospective review of a single-center database. Component ASD-FI parameters contributing to overall ASD-FI score were assessed via Pearson correlation. Top significant, clinically relevant factors were regressed against ASD-FI score to generate the modified ASD-FI (mASD-FI). Component mASD-FI factors were regressed against incidence of medical complications, and factor weights were calculated from regression of these coefficients. Total mASD-FI score ranged from 0 to 21, and was calculated by summing weights of expressed parameters. Linear regression and published ASD-FI cutoffs generated corresponding mASD-FI frailty cutoffs: not frail (NF, <7), frail (7-12), severely frail (SF, >12). Analysis of variance assessed the relationship between frailty category and validated baseline measures of pain and disability at baseline. RESULTS: The study included 50 ASD patients. Eight factors were included in the mASD-FI. Overall mean mASD-FI score was 5.7 ± 5.2. Combined, factors comprising the mASD-FI showed a trend of predicting the incidence of medical complications (Nagelkerke R 2 = 0.558; Cox & Snell R 2 = 0.399; P = .065). Breakdown by frailty category is NF (70%), frail (12%), and SF (18%). Increasing frailty category was associated with significant impairments in measures of pain and disability: Oswestry Disability Index (NF: 23.4; frail: 45.0; SF: 49.3; P < .001), SRS-22r (NF: 3.5; frail: 2.6; SF: 2.4; P = .001), Pain Catastrophizing Scale (NF: 41.9; frail: 32.4; SF: 27.6; P < .001), and NRS Leg Pain (NF: 2.3; frail: 7.2; SF: 5.6; P = .001). CONCLUSIONS: This study modifies an existing ASD frailty index and proposes a weighted, shorter mASD-FI. The mASD-FI relies less on patient-reported variables, and it weights component factors by their contribution to adverse outcomes. Because increasing mASD-FI score is associated with inferior clinical measures of pain and disability, the mASD-FI may serve as a valuable tool for preoperative risk assessment. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
Authors: Thomas N Robinson; Jeremy D Walston; Nathan E Brummel; Stacie Deiner; Charles H Brown; Maura Kennedy; Arti Hurria Journal: J Am Coll Surg Date: 2015-09-11 Impact factor: 6.113
Authors: Justin K Scheer; Joseph A Osorio; Justin S Smith; Frank Schwab; Robert A Hart; Richard Hostin; Virginie Lafage; Amit Jain; Douglas C Burton; Shay Bess; Tamir Ailon; Themistocles S Protopsaltis; Eric O Klineberg; Christopher I Shaffrey; Christopher P Ames Journal: Spine Deform Date: 2018 Sep - Oct
Authors: Justin S Smith; Christopher I Shaffrey; Shay Bess; Mohammed F Shamji; Darrel Brodke; Lawrence G Lenke; Michael G Fehlings; Virginie Lafage; Frank Schwab; Alexander R Vaccaro; Christopher P Ames Journal: Neurosurgery Date: 2017-03-01 Impact factor: 4.654
Authors: Justin S Smith; Virginie Lafage; Christopher I Shaffrey; Frank Schwab; Renaud Lafage; Richard Hostin; Michael OʼBrien; Oheneba Boachie-Adjei; Behrooz A Akbarnia; Gregory M Mundis; Thomas Errico; Han Jo Kim; Themistocles S Protopsaltis; D Kojo Hamilton; Justin K Scheer; Daniel Sciubba; Tamir Ailon; Kai-Ming G Fu; Michael P Kelly; Lukas Zebala; Breton Line; Eric Klineberg; Munish Gupta; Vedat Deviren; Robert Hart; Doug Burton; Shay Bess; Christopher P Ames Journal: Neurosurgery Date: 2016-06 Impact factor: 4.654
Authors: Garry R Barton; Tracey H Sach; Anthony J Avery; Claire Jenkinson; Michael Doherty; David K Whynes; Kenneth R Muir Journal: Health Econ Date: 2008-07 Impact factor: 3.046
Authors: Emily K Miller; Lawrence G Lenke; Brian J Neuman; Daniel M Sciubba; Khaled M Kebaish; Justin S Smith; Yong Qiu; Benny T Dahl; Ferran Pellisé; Yukihiro Matsuyama; Leah Y Carreon; Michael G Fehlings; Kenneth M Cheung; Stephen Lewis; Mark B Dekutoski; Frank J Schwab; Oheneba Boachie-Adjei; Hossein Mehdian; Shay Bess; Christopher I Shaffrey; Christopher P Ames Journal: Spine (Phila Pa 1976) Date: 2018-10-15 Impact factor: 3.468
Authors: Brian J Buta; Jeremy D Walston; Job G Godino; Minsun Park; Rita R Kalyani; Qian-Li Xue; Karen Bandeen-Roche; Ravi Varadhan Journal: Ageing Res Rev Date: 2015-12-07 Impact factor: 10.895