Development of a Modified Cervical Deformity Frailty Index: A Streamlined Clinical Tool for Preoperative Risk Stratification.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Feb 2019
01 Feb 2019
Historique:
pubmed:
14
7
2018
medline:
4
7
2019
entrez:
14
7
2018
Statut:
ppublish
Résumé
Retrospective review. Develop a simplified frailty index for cervical deformity (CD) patients. To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary. CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: Not Frail (NF, <0.3), Frail (0.3-0.5), Severely Frail (SF, >0.5). Means comparison tests established correlations between frailty category and clinical outcomes. Included: 121 CD patients (61 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]). Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective review.
OBJECTIVE
OBJECTIVE
Develop a simplified frailty index for cervical deformity (CD) patients.
SUMMARY OF BACKGROUND DATA
BACKGROUND
To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary.
METHODS
METHODS
CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: Not Frail (NF, <0.3), Frail (0.3-0.5), Severely Frail (SF, >0.5). Means comparison tests established correlations between frailty category and clinical outcomes.
RESULTS
RESULTS
Included: 121 CD patients (61 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]).
CONCLUSION
CONCLUSIONS
Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 30005037
doi: 10.1097/BRS.0000000000002778
pii: 00007632-201902010-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
169-176Références
Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications. J Neurosurg Spine 2013; 19:141–159.
Smith JS, Shaffrey CI, Bess S, et al. Recent and emerging advances in spinal deformity. Neurosurgery 2017; 80:S70–S85.
Miller EK, Ailon T, Neuman BJ, et al. Assessment of a novel adult cervical deformity frailty index as a component of preoperative risk stratification. World Neurosurg 2018; 109:e800–e806.
Mosquera C, Spaniolas K, Fitzgerald TL. Impact of frailty on surgical outcomes: the right patient for the right procedure. Surgery 2016; 160:272–280.
Ahmed AK, Goodwin CR, De la Garza-Ramos R, et al. Predicting short-term outcome after surgery for primary spinal tumors based on patient frailty. World Neurosurg 2017; 108:393–398.
Flexman AM, Charest-Morin R, Stobart L, et al. Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease. Spine J 2016; 16:1315–1323.
Leven DM, Lee NJ, Kothari P, et al. Frailty index is a significant predictor of complications and mortality after surgery for adult spinal deformity. Spine (Phila Pa 1976) 2016; 41:E1394–E1401.
Ali R, Schwalb JM, Nerenz DR, et al. Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J Neurosurg Spine 2016; 25:537–541.
Searle SD, Mitnitski A, Gahbauer EA, et al. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8:24.
McNeish DM. Using lasso for predictor selection and to assuage overfitting: a method long overlooked in behavioral sciences. Multivariate Behav Res 2015; 50:471–484.
Miller EK, Neuman BJ, Jain A, et al. An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery. Neurosurg Focus 2017; 43:E3.
Shin JI, Kothari P, Phan K, et al. Frailty index as a predictor of adverse postoperative outcomes in patients undergoing cervical spinal fusion. Spine (Phila Pa 1976) 2017; 42:304–310.
Fransen M, Edmonds J. Reliability and validity of the EuroQol in patients with osteoarthritis of the knee. Rheumatology (Oxford) 1999; 38:807–813.
Chotai S, Parker SL, Sivaganesan A, et al. Quality of life and general health after elective surgery for cervical spine pathologies: determining a valid and responsive metric of health state utility. Neurosurgery 2015; 77:553–60.
Passias PG, Horn SR, Bortz CA, et al. The relationship between improvements in myelopathy and sagittal realignment in cervical deformity surgery outcomes. Spine (Phila Pa 1976) 2018; [Epub ahead of print].
Yagi M, Fujita N, Okada E, et al. Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders. Spine (Phila Pa 1976) 2018; [Epub ahead of print].
Poorman GW, Passias PG, Horn SR, et al. Despite worse baseline status depressed patients achieved outcomes similar to those in nondepressed patients after surgery for cervical deformity. Neurosurg Focus 2017; 43:E10.
Passias PG, Bortz C, Horn S, et al. Drivers of cervical deformity have a strong influence on achieving optimal radiographic and clinical outcomes at 1 year after cervical deformity surgery. World Neurosurg 2018; 112:e61–e68.
Ailon T, Smith JS, Shaffrey CI, et al. Outcomes of operative treatment for adult cervical deformity: a prospective multicenter assessment with 1-year follow-up. Neurosurgery 2017; [Epub ahead of print].
Protopsaltis TS, Ramchandran S, Hamilton K, et al. Analysis of Successful vs. Failed Radiographic Outcomes following Cervical Deformity Surgery. Spine (Phila Pa 1976) 2017; [Epub ahead of print].