Frailty status as a predictor of 3-month cognitive and functional recovery following spinal surgery: a prospective pilot study.
Cognitive recovery
Elderly spinal surgery
Frailty
Functional recovery
Geriatric spinal surgery
Spinal rehabilitation
Journal
The spine journal : official journal of the North American Spine Society
ISSN: 1878-1632
Titre abrégé: Spine J
Pays: United States
ID NLM: 101130732
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
12
03
2018
revised:
30
04
2018
accepted:
16
05
2018
pubmed:
25
5
2018
medline:
4
1
2020
entrez:
25
5
2018
Statut:
ppublish
Résumé
As increasing numbers of elderly Americans undergo spinal surgery, it is important to identify which patients are at highest risk for poor cognitive and functional recovery. Frailty is a geriatric syndrome that has been closely linked to poor outcomes, and short-form screening may be a helpful tool for preoperative identification of at-risk patients. This study aimed to conduct a pilot study on the usefulness of a short-form screening tool to identify elderly patients at increased risk for prolonged cognitive and functional recovery following elective spine surgery. This is a prospective, comparative cohort study. The sample comprised 100 patients over age 65 who underwent elective spinal surgery (cervical or lumbar) at a single, large academic medical center from 2013 to 2014. Fatigue, Resistance, Ambulation, Illnesses, Loss of Weight (FRAIL) scale, Postoperative Quality of Recovery Scale (PQRS), and instrumental activities of daily living (IADL) scores were the outcome measures. Included patients were assessed with the FRAIL scale and stratified as robust, pre-frail, or frail. The PQRS and IADL scores were also obtained. Patients were re-examined at 1 day, 3 days, 1 month, and 3 months after surgery for cognitive recovery at 3 months, and secondarily, functional recovery at 3 months. At 3 months, only 50% of frail patients had recovered to their cognitive baseline compared with 60.7% of pre-frail and 69.2% of robust patients (trend). At 3 months, 66.7% of frail patients had recovered to their functional baseline compared with 57% of pre-frail and 76.9% of robust patients (trend). Using multivariate regression modeling, at 3 months, frail patients were less likely to have recovered to their cognitive baseline compared with pre-frail and robust patients (odds ratio 0.39, confidence interval 0.131-1.161). This pilot study demonstrates a trend toward poorer cognitive recovery 3 months following elective spinal surgery for frail patients. Frailty screening can help preoperatively identify patients who may experience protracted cognitive and functional recovery.
Sections du résumé
BACKGROUND CONTEXT
As increasing numbers of elderly Americans undergo spinal surgery, it is important to identify which patients are at highest risk for poor cognitive and functional recovery. Frailty is a geriatric syndrome that has been closely linked to poor outcomes, and short-form screening may be a helpful tool for preoperative identification of at-risk patients.
PURPOSE
This study aimed to conduct a pilot study on the usefulness of a short-form screening tool to identify elderly patients at increased risk for prolonged cognitive and functional recovery following elective spine surgery.
STUDY DESIGN/SETTING
This is a prospective, comparative cohort study.
PATIENT SAMPLE
The sample comprised 100 patients over age 65 who underwent elective spinal surgery (cervical or lumbar) at a single, large academic medical center from 2013 to 2014.
OUTCOME MEASURES
Fatigue, Resistance, Ambulation, Illnesses, Loss of Weight (FRAIL) scale, Postoperative Quality of Recovery Scale (PQRS), and instrumental activities of daily living (IADL) scores were the outcome measures.
METHODS
Included patients were assessed with the FRAIL scale and stratified as robust, pre-frail, or frail. The PQRS and IADL scores were also obtained. Patients were re-examined at 1 day, 3 days, 1 month, and 3 months after surgery for cognitive recovery at 3 months, and secondarily, functional recovery at 3 months.
RESULTS
At 3 months, only 50% of frail patients had recovered to their cognitive baseline compared with 60.7% of pre-frail and 69.2% of robust patients (trend). At 3 months, 66.7% of frail patients had recovered to their functional baseline compared with 57% of pre-frail and 76.9% of robust patients (trend). Using multivariate regression modeling, at 3 months, frail patients were less likely to have recovered to their cognitive baseline compared with pre-frail and robust patients (odds ratio 0.39, confidence interval 0.131-1.161).
CONCLUSIONS
This pilot study demonstrates a trend toward poorer cognitive recovery 3 months following elective spinal surgery for frail patients. Frailty screening can help preoperatively identify patients who may experience protracted cognitive and functional recovery.
Identifiants
pubmed: 29792992
pii: S1529-9430(18)30251-1
doi: 10.1016/j.spinee.2018.05.026
pmc: PMC6358015
mid: NIHMS1512983
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
104-112Subventions
Organisme : NIA NIH HHS
ID : K23 AG048332
Pays : United States
Organisme : NIA NIH HHS
ID : R03 AG040624
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
Références
Anesthesiology. 2008 Jan;108(1):18-30
pubmed: 18156878
Spine (Phila Pa 1976). 2007 Feb 1;32(3):342-7
pubmed: 17268266
J Am Coll Surg. 2010 Jun;210(6):901-8
pubmed: 20510798
Neurosurg Focus. 2017 Dec;43(6):E3
pubmed: 29191099
PLoS One. 2016 Jun 14;11(6):e0157377
pubmed: 27300577
J Nutr Health Aging. 2012 Jul;16(7):601-8
pubmed: 22836700
Am J Surg. 2013 Oct;206(4):544-50
pubmed: 23880071
Global Spine J. 2017 Sep;7(6):529-535
pubmed: 28894682
Spine J. 2017 Apr;17(4):538-544
pubmed: 27989724
J Am Coll Surg. 2004 Nov;199(5):762-72
pubmed: 15501119
Surg Neurol Int. 2011;2:188
pubmed: 22276241
J Nutr Health Aging. 2016;20(8):854-859
pubmed: 27709235
ScientificWorldJournal. 2001 Aug 08;1:323-36
pubmed: 12806071
Int J Geriatr Psychiatry. 2005 Sep;20(9):827-34
pubmed: 16116577
J Am Geriatr Soc. 2014 Apr;62(4):721-6
pubmed: 24635726
Am J Surg. 2011 Nov;202(5):511-4
pubmed: 21890098
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
pubmed: 11253156
J Am Geriatr Soc. 2013 Dec;61(12):2128-34
pubmed: 24479144
Spine Deform. 2016 Nov;4(6):420-424
pubmed: 27927571
Acta Anaesthesiol Scand. 2009 Oct;53(9):1230
pubmed: 19737190
JAMA. 2010 Apr 7;303(13):1259-65
pubmed: 20371784
J Alzheimers Dis. 2016 Jun 15;53(3):1003-13
pubmed: 27314525
J Am Geriatr Soc. 2014 Feb;62(2):285-90
pubmed: 24521364
Arch Intern Med. 2002 Nov 11;162(20):2269-76
pubmed: 12418941
Spine (Phila Pa 1976). 2017 Sep 1;42(17):1347-1354
pubmed: 28146019
J Am Geriatr Soc. 2013 Sep;61(9):1537-51
pubmed: 24028357
Curr Opin Anaesthesiol. 2014 Jun;27(3):330-5
pubmed: 24566452