Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Apr 2020
01 Apr 2020
Historique:
pubmed:
28
10
2019
medline:
25
8
2020
entrez:
26
10
2019
Statut:
ppublish
Résumé
Retrospective review of a prospective database. The aim of this study was to evaluate postop clinical recovery among adult spinal deformity (ASD) patients between frailty states undergoing primary procedures SUMMARY OF BACKGROUND DATA.: Frailty severity may be an important determinant for impaired recovery after corrective surgery. It included ASD patients with health-related quality of life (HRQLs) at baseline (BL), 1 year (1Y), and 3 years (3Y). Patients stratified by frailty by ASD-frailty index scale 0-1(no frailty: <0.3 [NF], mild: 0.3-0.5 [MF], severe: >0.5 [SF]). Demographics, alignment, and SRS-Schwab modifiers were assessed with χ/paired t tests to compare HRQLs: Scoliosis Research Society 22-question Questionnaire (SRS-22), Numeric Rating Scale (NRS) Back/Leg Pain, Oswestry Disability Index (ODI). Area-under-the-curve (AUC) method generated normalized HRQL scores at baseline (BL) and f/u intervals (1Y, 3Y). AUC was calculated for each f/u, and total area was divided by cumulative f/u, generating one number describing recovery (Integrated Health State [IHS]). A total of 191 patients were included (59 years, 80% females). Breakdown of patients by frailty status: 43.6% NF, 40.8% MF, 15.6% SF. SF patients were older (P = 0.003), >body mass index (P = 0.002). MF and SF were significantly (P < 0.001) more malaligned at BL: pelvic tilt (NF: 21.6°; MF: 27.3°; SF: 22.1°), pelvic incidence and lumbar lordosis (7.4°, 21.2°, 19.7°), sagittal vertical axis (31 mm, 87 mm, 82 mm). By SRS-Schwab, NF were mostly minor (40%), and MF and SF markedly deformed (64%, 57%). Frailty groups exhibited BL to 3Y improvement in SRS-22, ODI, NRS Back/Leg (P < 0.001). After HRQL normalization, SF had improvement in SRS-22 at year 1 and year 3 (P < 0.001), and NRS Back at 1Y. 3Y IHS showed a significant difference in SRS-22 (NF: 1.2 vs. MF: 1.32 vs. SF: 1.69, P < 0.001) and NRS Back Pain (NF: 0.52, MF: 0.66, SF: 0.6, P = 0.025) between frailty groups. SF had more complications (79%). SF/marked deformity had larger invasiveness score (112) compared to MF/moderate deformity (86.2). Controlling for baseline deformity and invasiveness, SF showed more improvement in SRS-22 IHS (NF: 1.21, MF: 1.32, SF: 1.66, P < 0.001). Although all frailty groups exhibited improved postop disability/pain scores, SF patients recovered better in SRS-22 and NRS Back. Despite SF patients having more complications and larger invasiveness scores, they had overall better patient-reported outcomes, signifying that with frailty severity, patients have more room for improvement postop compared to BL quality of life. 3.
Identifiants
pubmed: 31651683
doi: 10.1097/BRS.0000000000003288
pii: 00007632-202004010-00012
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E397-E405Références
Searle SD, Mitnitski A, Gahbauer EA, et al. A standard procedure for creating a frailty index. BMC Geriatr 2008; 8:24.
Rockwood K, Blodgett JM, Theou O, et al. A frailty index based on deficit accumulation quantifies mortality risk in humans and in mice. Sci Rep 2017; 7:1–10.
Stow D, Matthews FE, Barclay S, et al. Evaluating frailty scores to predict mortality in older adults using data from population based electronic health records: case control study. Age Ageing 2018; 47:564–569.
Lin H-S, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 2016; 16:157.
Hall DE, Arya S, Schmid KK, et al. Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg 2017; 152:233–240.
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.
Rothrock RJ, Steinerger JM, Badgery H, et al. Frailty status as a predictor of three month cognitive and functional recovery following spinal surgery: a prospective pilot study. Spine J 2019; 19:104–112.
Liu S, Tetreault L, Fehlings MG, et al. A novel method using baseline normalization and area under the curve to evaluate differences in outcome between treatment groups and application to patients with cervical spondylotic myelopathy undergoing anterior versus posterior surgery. Spine (Phila Pa 1976) 2015; 40:E1299–E1304.
Segreto FA, Lafage V, Lafage R, et al. Recovery kinetics: comparison of patients undergoing primary or revision procedures for adult cervical deformity using a novel area under the curve methodology. Neurosurgery 2019; 85:E40–E51.
Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47:1245–1251.
Champain S, Benchikh K, Nogier a, et al. Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies. Eur Spine J 2006; 15:982–991.
Rillardon L, Levassor N, Guigui P, et al. Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Rev Chir Orthop Reparatrice Appar Mot 2003; 89:218–227.
O’Brien MF, Kuklo TRTR, Blanke KM, et al. Spinal Deformity Study Group Radiographic Measurement Manual. Available at: http://www.oref.org/docs/default-source/default-document-library/sdsg-radiographic-measuremnt-manual.pdf?sfvrsn=2. 2005.
Terran J, Schwab FJ, Shaffrey CI, et al. The SRS-Schwab Adult Spinal Deformity Classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 2013; 73:559–568.
Schwab F, Ungar B, Blondel B, et al. SRS-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012; 37:1077–1082.
Passias PG, Jalai CM, Lafage V, et al. Kinetics of radiographic and implant-related revision patients following adult spinal deformity surgery. Neurosurgery 2018; 83:700–708.
Ames CP, Scheer JK, Mundis GM, et al. The Effect of Patient Age on Recovery Kinetics in 149 Adult Spinal Deformity Patients with 2-year Follow-up: A Novel Area Under the Curve Analysis. In: Scoliosis Research Society (SRS); September 10-13. Anchorage, Alaska; 2014.
Leven D, Cho SK. Pseudarthrosis of the cervical spine: risk factors, diagnosis and management. Asian Spine J 2016; 10:776–786.
Miller EK, Lenke LG, Neuman BJ, et al. External Validation of the Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) in the Scoli-RISK-1 Patient Database. Spine (Phila Pa 1976) 2018; 875:61.
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; 1.
Yagi M, Hosogane N, Fujita N, et al. Predictive model for major complications 2 years after corrective spine surgery for adult spinal deformity. Eur spine J 2019; 28:180–187.
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.
Glassman SD, Bridwell KH, Shaffrey CI, et al. Health-related quality of life scores underestimate the impact of major complications in lumbar degenerative scoliosis surgery. Spine Deform 2018; 6:67–71.
Reid DBCC, Daniels AH, Ailon T, et al. Frailty and health-related quality of life improvement following adult spinal deformity surgery. World Neurosurg 2018; 112:548–554.
Reid DBCC, Daniels AH, Ailon T, et al. Patient satisfaction after adult spinal deformity surgery does not strongly correlate with health-related quality of life scores, radiographic parameters, or occurrence of complications. Spine (Phila Pa1976) 2017; 42:764–769.
Cho SK, Bridwell KH, Lenke LG, et al. Major complications in revision adult deformity surgery: risk factors and clinical outcomes with 2- to 7-year follow-up. Spine (Phila Pa 1976) 2012; 37:489–500.