Peter G Passias1,2, Frank A Segreto3, Kevin A Moattari3, Renaud Lafage4, Justin S Smith5, Breton G Line6, Robert K Eastlack7, Douglas C Burton8, Robert A Hart9, Shay Bess10, Christopher I Shaffrey5, Christopher P Ames11, Virginie Lafage4. 1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. pgpassias@yahoo.com. 2. Department of Orthopaedic Surgery, New York Spine Institute, NYU Medical Center-Hospital for Joint Diseases, 301 East 17th St, New York, NY, 10003, USA. pgpassias@yahoo.com. 3. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. 4. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. 5. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. 6. Department of Orthopedic Surgery, Rocky Mountain Scoliosis and Spine Center, Denver, CO, USA. 7. Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA. 8. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA. 9. Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA. 10. Rocky Mountain Scoliosis and Spine, Denver, CO, USA. 11. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
Abstract
PURPOSE: Frailty has been associated with adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity was developed. Components of the ASD-FI utilize patient comorbidity, clinical symptoms, and patient-reported-outcome-measures (PROMS). Our purpose was to investigate components of the Adult Spinal Deformity Frailty Index (ASD-FI) responsive to surgery and drivers of overall frailty. METHODS: Operative ASD patients ≥ 18 years, undergoing multilevel fusions, with complete baseline, 6 W, 1Y and 2Y ASD-FI scores. Descriptive analysis assessed demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t tests assessed postoperative changes to ASD-FI components, total score, and radiographic parameters. Linear regression models determined the effect of successful surgery (achieving lowest level SRS-Schwab classification modifiers) on change in ASD-FI total scores. RESULTS: 409 6-week, 696 1-year, and 253 2-year operative ASD patients were included. 6-week and 1-year baseline frailty scores were 0.34, 2 years was 0.38. Following surgery, 6-week frailty was 0.36 (p = 0.033), 1 year was 0.25 (p < 0.001), and 2 years was 0.28 (p < 0.001). Of the ASD-FI variables, 17/40 improved at 6 weeks, 21/40 at 1 year, and 18/40 at 2 years. Successful surgery significantly predicted decreases in 1-year frailty scores (R = 0.27, p < 0.001), SRS-Schwab SVA modifier was the greatest predictor (Adjusted Beta: - 0.29, p < 0.001). CONCLUSIONS: Improvement in sagittal realignment and functional status correlated with improved postoperative frailty. Additional research and deformity sub-group analyses are needed to describe associations between specific functional activities that correlated with frailty improvement as well as evaluation of modifiable and non-modifiable indices.
PURPOSE: Frailty has been associated with adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity was developed. Components of the ASD-FI utilize patient comorbidity, clinical symptoms, and patient-reported-outcome-measures (PROMS). Our purpose was to investigate components of the Adult Spinal Deformity Frailty Index (ASD-FI) responsive to surgery and drivers of overall frailty. METHODS: Operative ASD patients ≥ 18 years, undergoing multilevel fusions, with complete baseline, 6 W, 1Y and 2Y ASD-FI scores. Descriptive analysis assessed demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t tests assessed postoperative changes to ASD-FI components, total score, and radiographic parameters. Linear regression models determined the effect of successful surgery (achieving lowest level SRS-Schwab classification modifiers) on change in ASD-FI total scores. RESULTS: 409 6-week, 696 1-year, and 253 2-year operative ASD patients were included. 6-week and 1-year baseline frailty scores were 0.34, 2 years was 0.38. Following surgery, 6-week frailty was 0.36 (p = 0.033), 1 year was 0.25 (p < 0.001), and 2 years was 0.28 (p < 0.001). Of the ASD-FI variables, 17/40 improved at 6 weeks, 21/40 at 1 year, and 18/40 at 2 years. Successful surgery significantly predicted decreases in 1-year frailty scores (R = 0.27, p < 0.001), SRS-Schwab SVA modifier was the greatest predictor (Adjusted Beta: - 0.29, p < 0.001). CONCLUSIONS: Improvement in sagittal realignment and functional status correlated with improved postoperative frailty. Additional research and deformity sub-group analyses are needed to describe associations between specific functional activities that correlated with frailty improvement as well as evaluation of modifiable and non-modifiable indices.
Authors: Sayf S A Faraj; Miranda L van Hooff; Roderick M Holewijn; David W Polly; Tsjitske M Haanstra; Marinus de Kleuver Journal: Eur Spine J Date: 2017-05-22 Impact factor: 3.134
Authors: Jamie Terran; Brian J McHugh; Charla R Fischer; Baron Lonner; Daniel Warren; Steven Glassman; Keith Bridwell; Frank Schwab; Virginie Lafage Journal: Ochsner J Date: 2014
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: Ferran Pellisé; Alba Vila-Casademunt; Montse Ferrer; Montse Domingo-Sàbat; Juan Bagó; Francisco J S Pérez-Grueso; Ahmet Alanay; A F Mannion; Emre Acaroglu Journal: Eur Spine J Date: 2014-09-14 Impact factor: 3.134
Authors: Olivia J Bono; Gregory W Poorman; Norah Foster; Cyrus M Jalai; Samantha R Horn; Jonathan Oren; Alexandra Soroceanu; Subaraman Ramachandran; Taylor E Purvis; Deeptee Jain; Shaleen Vira; Bassel G Diebo; Breton Line; Daniel M Sciubba; Themistocles S Protopsaltis; Aaron J Buckland; Thomas J Errico; Virginie Lafage; Shay Bess; Peter G Passias Journal: Spine J Date: 2017-11-16 Impact factor: 4.166
Authors: Jamie Terran; Frank Schwab; Christopher I Shaffrey; Justin S Smith; Pierre Devos; Christopher P Ames; Kai-Ming G Fu; Douglas Burton; Richard Hostin; Eric Klineberg; Munish Gupta; Vedat Deviren; Gregory Mundis; Robert Hart; Shay Bess; Virginie Lafage Journal: Neurosurgery Date: 2013-10 Impact factor: 4.654
Authors: Samuel D Searle; Arnold Mitnitski; Evelyne A Gahbauer; Thomas M Gill; Kenneth Rockwood Journal: BMC Geriatr Date: 2008-09-30 Impact factor: 3.921