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Ton A, Wishart D, Ball JR, Shah I, Murakami K, Ordon MP, Alluri RK, Hah R, Safaee MM. The Evolution of Risk Assessment in Spine Surgery: A Narrative Review. World Neurosurg 2024; 188:1-14. [PMID: 38677646 DOI: 10.1016/j.wneu.2024.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Risk assessment is critically important in elective and high-risk interventions, particularly spine surgery. This narrative review describes the evolution of risk assessment from the earliest instruments focused on general surgical risk stratification, to more accurate and spine-specific risk calculators that quantified risk, to the current era of big data. METHODS The PubMed and SCOPUS databases were queried on October 11, 2023 using search terms to identify risk assessment tools (RATs) in spine surgery. A total of 108 manuscripts were included after screening with full-text review using the following inclusion criteria: 1) study population of adult spine surgical patients, 2) studies describing validation and subsequent performance of preoperative RATs, and 3) studies published in English. RESULTS Early RATs provided stratified patients into broad categories and allowed for improved communication between physicians. Subsequent risk calculators attempted to quantify risk by estimating general outcomes such as mortality, but then evolved to estimate spine-specific surgical complications. The integration of novel concepts such as invasiveness, frailty, genetic biomarkers, and sarcopenia led to the development of more sophisticated predictive models that estimate the risk of spine-specific complications and long-term outcomes. CONCLUSIONS RATs have undergone a transformative shift from generalized risk stratification to quantitative predictive models. The next generation of tools will likely involve integration of radiographic and genetic biomarkers, machine learning, and artificial intelligence to improve the accuracy of these models and better inform patients, surgeons, and payers.
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Affiliation(s)
- Andy Ton
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Danielle Wishart
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jacob R Ball
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ishan Shah
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kiley Murakami
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Matthew P Ordon
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - R Kiran Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael M Safaee
- Department of Neurological Surgery, Keck School of MedicineUniversity of Southern California, Los Angeles, California, USA.
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Mauria R, Kumar P, Yaffe NM, Labak CM, Herring EZ, Azghadi A, Kasliwal MK. The 5-Item Modified Frailty Index as a Predictor of Postoperative Outcomes in Thoracic Metastatic Epidural Spinal Cord Compression. World Neurosurg 2024; 188:e267-e272. [PMID: 38777316 DOI: 10.1016/j.wneu.2024.05.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Patients with thoracic metastatic epidural spinal cord compression (MESCC) often undergo extensive surgical decompression to avoid functional decline. Though limited in scope, scales including the revised cardiac risk index (RCRI) are used to stratify surgical risk to predict perioperative morbidity. This study uses the 5-item modified frailty index (mFI-5) to predict outcomes following transpedicular decompression/fusion for high-grade MESCC. METHODS A retrospective chart review was conducted on patients who underwent transpedicular decompression and fusion for MESCC (baseline demographics, spinal instability neoplastic score, preoperative and postoperative Bilsky scores, primary cancer type, and RCRI). Primary outcomes included length of stay (LOS), intraoperative estimated blood loss, readmission/reoperation within 90 days of index surgery, 90-day mortality, and posthospitalization disposition. RESULTS One hundred twenty-seven patients were included in our study. Ninety percent of patients' lesions were Bilsky 2 or greater. Increasing frailty, measured by mFI-5, was a significant predictor of increased LOS (P < 0.01) and 90-day mortality (P < 0.05). Multivariate analysis adjusting for sex, body mass index , and age still showed statistical significance (P < 0.05). MFI-5 was not a significant predictor of readmission/reoperation within 90 days or estimated blood loss. Age - not mFI-5 or RCRI - was a significant predictor for posthospitalization nonhome disposition (P = 0.001). CONCLUSIONS The mFI-5 can serve as a useful predictor of outcomes after transpedicular decompression and fusion for thoracic MESCC as it can account for the patient's frailty. Our study demonstrated the mFI-5 as a predictor of LOS and 90-day mortality. These results provide a background to both understanding and integrating frailty into decision-making in MESCC.
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Affiliation(s)
- Rohit Mauria
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Pranav Kumar
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Noah M Yaffe
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Collin M Labak
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Eric Z Herring
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Adel Azghadi
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Manish K Kasliwal
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Findlay MC, Rennert RC, Lucke-Wold B, Couldwell WT, Evans JJ, Collopy S, Kim W, Delery W, Pacione DR, Kim AH, Silverstein JM, Kanga M, Chicoine MR, Gardner PA, Valappil B, Abdallah H, Sarris CE, Hendricks BK, Torok IE, Low TM, Crocker TA, Yuen KCJ, Vigo V, Fernandez-Miranda JC, Kshettry VR, Little AS, Karsy M. Impact of Frailty on Surgical Outcomes of Patients With Cushing Disease Using the Multicenter Registry of Adenomas of the Pituitary and Related Disorders Registry. Neurosurgery 2024:00006123-990000000-01271. [PMID: 38985563 DOI: 10.1227/neu.0000000000003090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/10/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite growing interest in how patient frailty affects outcomes (eg, in neuro-oncology), its role after transsphenoidal surgery for Cushing disease (CD) remains unclear. We evaluated the effect of frailty on CD outcomes using the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) data set from a collaboration of US academic pituitary centers. METHODS Data on consecutive surgically treated patients with CD (2011-2023) were compiled using the 11-factor modified frailty index. Patients were classified as fit (score, 0-1), managing well (score, 2-3), and mildly frail (score, 4-5). Univariable and multivariable analyses were conducted to examine outcomes. RESULTS Data were analyzed for 318 patients (193 fit, 113 managing well, 12 mildly frail). Compared with fit and managing well patients, mildly frail patients were older (mean ± SD 39.7 ± 14.2 and 48.9 ± 12.2 vs 49.4 ± 8.9 years, P < .001) but did not different by sex, race, and other factors. They had significantly longer hospitalizations (3.7 ± 2.0 and 4.5 ± 3.5 vs 5.3 ± 3.5 days, P = .02), even after multivariable analysis (β = 1.01, P = .007) adjusted for known predictors of prolonged hospitalization (age, Knosp grade, surgeon experience, American Society of Anesthesiologists grade, complications, frailty). Patients with mild frailty were more commonly discharged to skilled nursing facilities (0.5% [1/192] and 4.5% [5/112] vs 25% [3/12], P < .001). Most patients underwent gross total resection (84.4% [163/193] and 79.6% [90/113] vs 83% [10/12]). No difference in overall complications was observed; however, venous thromboembolism was more common in mildly frail (8%, 1/12) than in fit (0.5%, 1/193) and managing well (2.7%, 3/113) patients (P = .04). No difference was found in 90-day readmission rates. CONCLUSION These results demonstrate that mild frailty predicts CD surgical outcomes and may inform preoperative risk stratification. Frailty-influenced outcomes other than age and tumor characteristics may be useful for prognostication. Future studies can help identify strategies to reduce disease burden for frail patients with hypercortisolemia.
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Affiliation(s)
- Matthew C Findlay
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Robert C Rennert
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - James J Evans
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Collopy
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Won Kim
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - William Delery
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Donato R Pacione
- Department of Neurosurgery, Lagone Medical Center, New York University, New York, New York, USA
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Julie M Silverstein
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Endocrinology, Metabolism & Lipid Research, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mridu Kanga
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael R Chicoine
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Benita Valappil
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hussein Abdallah
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christina E Sarris
- Department of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ildiko E Torok
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Trevor M Low
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tomiko A Crocker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kevin C J Yuen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Vera Vigo
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, USA
| | | | - Varun R Kshettry
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrew S Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael Karsy
- Global Neurosciences Institute, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Li R, Sidawy A, Nguyen BN. The 5-Factor Modified Frailty Index is a Succinct yet Effective Predictor of Adverse Outcomes in Patients Undergoing Open Surgery for Abdominal Aortic Aneurysm. Ann Vasc Surg 2024; 104:139-146. [PMID: 38492726 DOI: 10.1016/j.avsg.2023.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 03/18/2024]
Abstract
BACKGROUND Frailty is an age-related, clinically recognizable state marked by increased susceptibility. The 5-item Modified Frailty Index (mFI-5) offers a concise assessment of frailty and has demonstrated its efficacy in various surgical fields. While the mFI-5 has been validated for endovascular aneurysm repair for abdominal aortic aneurysm (AAA), its applicability in open surgical repair (OSR) for AAA remains largely unexplored. This study sought to evaluate the utility of mFI-5 in predicting 30-day outcomes following OSR for AAA. METHODS Patients underwent OSR for AAA were identified in American College of Surgeons National Surgical Quality Improvement Program-targeted database from 2012 to 2021. Patients were stratified into 3 cohorts: mFI-5 score of 0 (control), 1, and 2+. Multivariable logistic regression was used to compare 30-day perioperative outcomes between frail patients and controls adjusting preoperative variables with P value <0.1. RESULTS Of the 5,249 patients who underwent OSR for AAA, 1,043 were controls, 2,938 had an mFI-5 score of 1 and 1,268 had an mFI-5 score of 2+. When compared to the control group, patients with an mFI-5 = 1 were more likely to have pulmonary events (adjusted odds ratio (aOR) = 1.452, P < 0.01), bleeding events (aOR = 1.33, P < 0.01), wound complications (aOR = 2.214, P < 0.01), ischemic colitis (aOR = 1.616, P = 0.01), and unplanned reoperation (aOR = 1.292, P = 0.04). Those with an mFI-5 = 2+ demonstrated higher risks of mortality (aOR = 1.709, P < 0.01), major adverse cardiovascular events (aOR = 1.347, P = 0.04), pulmonary events (aOR = 2.045, P < 0.01), renal dysfunction (aOR = 1.568, P < 0.01), sepsis (aOR = 1.587, P = 0.01), bleeding events (aOR = 1.429, P < 0.01), wound complications (aOR = 2.338, P < 0.01), ischemic colitis (aOR = 1.775, P = 0.01), unplanned reoperation (aOR = 1.445, P = 0.01), operation over 4 hours (aOR = 1.34, P < 0.01), length of stay over 7 days (aOR = 1.324, <0.01), discharge not to home (aOR = 1.547, P < 0.01), 30-day readmission (aOR = 1.657, P = 0.01). CONCLUSIONS The mFI-5 emerges as a succinct yet effective indicator of frailty for patients undergoing OSR for AAA. Especially, an mFI-5 score of 2+ is linked with increased 30-day mortality and complications. As such, mFI-5 can be used as a valuable screening tool for frailty in patients undergoing OSR for AAA.
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Affiliation(s)
- Renxi Li
- School of Medicine and Health Sciences, The George Washington University, Washington, DC; Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, DC.
| | - Anton Sidawy
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, DC
| | - Bao-Ngoc Nguyen
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, DC
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Rubel KE, Lopez A, Lubner RJ, Lee DL, Yancey K, Chandra RK, Chowdhury NI, Turner JH. Frailty is an independent predictor of postoperative rescue medication use after endoscopic sinus surgery. Int Forum Allergy Rhinol 2024; 14:1218-1225. [PMID: 38268092 PMCID: PMC11219267 DOI: 10.1002/alr.23324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/01/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The modified five-item frailty index (mFI-5) is a validated risk stratification tool with the ability to predict adverse outcomes following surgery. In this study, we sought to use mFI-5 to assess the potential relationship between unhealthy aging and postoperative endoscopic sinus surgery (ESS) outcomes. METHODS Patients who underwent sinus surgery at Vanderbilt between 2014 and 2018 were identified and assessed using the mFI-5, which is calculated based on the presence of five comorbidities: diabetes mellitus, hypertension requiring medication, chronic obstructive pulmonary disease, congestive heart failure, and non-independent functional status. Multivariate regression analyses were performed to quantify the association of mFI-5 score on need for rescue oral antibiotics, oral steroids, and antibiotic irrigations within 1 year following ESS, adjusting for relevant potential confounders. RESULTS Four hundred and three patients met inclusion criteria. Within 6 months of surgery, 312 (77%) required rescue antibiotics, 243 (60%) required oral corticosteroids (OCS), and 31 (8%) initiated antibiotic irrigations. Increasing mFI-5 scores were significantly associated with higher postoperative use of rescue antibiotics (p < 0.0001), OCS (p = 0.032), and antibiotic irrigation (p < 0.0001). Frailty scores remained as an independent predictor of these outcomes after adjustment for age, polyp status, preoperative sinonasal outcomes test (SNOT-22) score, and revision surgery status. CONCLUSIONS Modified frailty scores may be a useful clinical tool to predict the need for postoperative rescue medication use after ESS.
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Affiliation(s)
- Kolin E. Rubel
- Department of Otolaryngology-Head and Neck Surgery; University of Minnesota Medical Center; Minneapolis, MN 55455
| | - Andrea Lopez
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University Medical Center; Nashville, TN 37232
| | - Rory J. Lubner
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University Medical Center; Nashville, TN 37232
| | - Diane L Lee
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University Medical Center; Nashville, TN 37232
| | - Kristen Yancey
- Department of Otolaryngology-Head and Neck Surgery; Weill Cornell Medicine; New York, NY 10021
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University Medical Center; Nashville, TN 37232
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University Medical Center; Nashville, TN 37232
| | - Justin H. Turner
- Department of Otolaryngology-Head and Neck Surgery; Vanderbilt University Medical Center; Nashville, TN 37232
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Ratna S, Annadata V, Chou DW, Rosenberg JD, Gray ML. The impact of frailty on facial nerve recovery following Bell's palsy. Am J Otolaryngol 2024; 45:104276. [PMID: 38604099 DOI: 10.1016/j.amjoto.2024.104276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Patients with Bell's palsy, the sudden onset of facial paralysis, have variable recovery. Frailty has been recognized as an important factor in predicting recovery. This study investigated the relationship between frailty and facial nerve recovery in Bell's palsy patients. METHODS A retrospective review was conducted on 95 Bell's palsy patients at a single institution's Department of Otolaryngology from 2014 to 2023. A clinically relevant facial nerve recovery was defined as a House-Brackmann (HB) score decrease>1 between the initial and most recent visit. Patients without follow-up visits or initial HB scores <3 were excluded. Frailty was measured by modified frailty index-5 (mFI-5) at the time of Bell's palsy diagnosis. Elderly patients were those over 65 years at presentation (n = 29). Frail patients had mFI-5 > 1 (n = 8). Chi-squared analyses, Fisher's exact tests, and logistic regression models were conducted in SPSS. RESULTS The analytic sample included 95 patients (median age = 56.8 years, IQR = 24.1) presenting with an initial HB score > 2. 36 % of patients' HB scores decreased by ≥2 within the follow-up period. Frailty (unadjusted Odds Ratio (OR) = 6.3, 95 % CI = [1.2, 33.1], p = .023) was associated with facial nerve recovery while age was not (unadjusted OR = 1.07, 95 % CI = [0.44, 2.59], p = .889). The mFI-5 adjusted OR was 8.43 (95 % CI = [1.38, 51.4], p = .021) when adjusting for age, gender, treatment modality, access to care, and follow-up duration in a logistic regression. CONCLUSIONS Frailty correlated with enhanced facial nerve recovery after Bell's palsy in this cohort; age was not significantly associated. Further investigation into factors associated with frailty, including increased surveillance and treatment frequency, is warranted.
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Affiliation(s)
- Sujay Ratna
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Vivek Annadata
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - David W Chou
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua D Rosenberg
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mingyang L Gray
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bray DP, Stubbs NM, Chow J, Jahangiri A, Nduom EK, Olson JJ, Hoang KB. Frailty in patients with IDH-mutant gliomas: experience from a high-volume tumor center. J Neurooncol 2024; 168:435-443. [PMID: 38833032 DOI: 10.1007/s11060-024-04685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/17/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Gliomas are increasingly diagnosed in an aging population, with treatment outcomes influenced by factors like tumor genetics and patient frailty. This study focused on IDH-mutant gliomas and assessed how frailty affects 30-day readmission and overall survival (OS). We aimed to address a gap in understanding the impact of frailty on this specific glioma subtype. METHODS 136 patients with an IDH-mutant glioma between 2007 and 2021 were identified at our institution. High frailty was classified by scores ≥ 1 on the 5-factor modified frailty index (mFI-5) and ≥ 3 on the Charlson Comorbidity Index (CCI). Patient and tumor characteristics including age, sex, race, Karnofsky Performance Status (KPS), Body Mass Index (BMI), tumor type and location, type of operation, and therapy course were recorded. Outcomes measured included 30-day readmission and overall survival (OS). Analysis was conducted utilizing logistic regression and Kaplan-Meier curves. RESULTS Of the 136 patients, 52 (38%) had high frailty: 18 with CCI ≥ 3, 34 with mFI-5 ≥ 1. High frailty correlated with increased BMI (CCI: 30.2, mFI-5: 30.1 kg/m2), more neurological deficits (CCI: 61%, mFI-5: 56%), and older age at surgery (CCI: 63, mFI-5: 48 years). Hospital readmission within 30 days occurred in 8 (5.9%) patients. Logistic regression indicated no significant difference in 30-day readmission rates (CCI: p = 0.30, mFI-5: p = 0.62) or median OS between high and low frailty groups. However, patients treated at our institution with newly diagnosed tumors with high mFI-5 had a 6.79 times higher adjusted death hazard than those with low mFI-5 (p = .049). CONCLUSION Our analysis revealed that CCI and mFI-5 were not significantly associated with 30-day nor OS. However, in patients with non-recurrent tumors, there was a significant association of mFI-5 with OS. Further study of frailty with larger cohorts is warranted to enhance prognostication of outcome after neurosurgical treatment.
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Affiliation(s)
- David P Bray
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Nolan M Stubbs
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
| | - Jocelyn Chow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Arman Jahangiri
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Edjah K Nduom
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kimberly B Hoang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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8
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Taghlabi KM, Quaddoura AA, Nisar A, Gupta P, Bhenderu LS, Guerrero JR, Tahanis A, Somawardana IA, Nanda R, Faraji AH. Modified 5-Item Frailty Index: A Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity and Mortality Following Surgical Fixation of Thoracolumbar Fractures. World Neurosurg 2024; 187:e1062-e1071. [PMID: 38744375 DOI: 10.1016/j.wneu.2024.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool to predict adverse events following various neurologic surgeries. This study aims to quantify the association between increased mFI-5 and postoperative complications and mortality following surgical fixation of traumatic thoracolumbar fractures. METHODS The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. The mFI-5 score was calculated based on the presence of 5 major comorbidities: congestive heart failure within 30 days before surgery, insulin-dependent or noninsulin-dependent diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at the time of surgery, and hypertension requiring medication. Multivariate analysis assessed the independent impact of increasing mFI-5 scores on postoperative 30-day morbidity and mortality while controlling for baseline clinical characteristics. RESULTS A total of 66,904 patients were included in our analysis (54.2% female, mean age 62.27 ± 12.93 years). On univariate analysis, higher mFI-5 score was significantly associated with increased risks of superficial surgical site infection, deep surgical site infection, wound dehiscence, unplanned reoperation, pneumonia, unplanned intubation, postoperative ventilator use, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke, myocardial infarction, cardiac arrest, pulmonary embolism, deep vein thrombosis, bleeding requiring transfusion, sepsis, septic shock, and longer hospital length of stay (LOS). On multivariate logistic regression, increasing mFI-5 score versus a mFI-5 score of zero was associated with higher odds of overall complications (mFI-5 ≥2: odds ratio [OR] 1.38 CI: 1.24-1.54, P < 0.001; mFI-5 = 1: OR 1.18 CI: 1.11-1.24, P < 0.001) and 30-day mortality (mFI-5 ≥2: OR 2.33 CI: 1.60-3.38, P < 0.001). CONCLUSION This study demonstrates that frailty, when measured using the mFI-5, independently predicts postoperative complications, hospital LOS, and 30-day mortality after surgical repair of thoracolumbar fractures. These findings are important for risk stratification in patients undergoing thoracolumbar fusion surgery and for standardization in reporting outcomes after those procedures.
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Affiliation(s)
- Khaled M Taghlabi
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas.
| | - Ahmad A Quaddoura
- McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Arsalan Nisar
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas; Texas A&M University School of Engineering Medicine, Houston, Texas
| | - Paras Gupta
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas; Texas A&M University School of Engineering Medicine, Houston, Texas
| | - Lokeshwar S Bhenderu
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Jaime R Guerrero
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
| | - Aboud Tahanis
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas
| | - Isuru A Somawardana
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas; Texas A&M University School of Engineering Medicine, Houston, Texas
| | - Rijul Nanda
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas; Texas A&M University School of Engineering Medicine, Houston, Texas
| | - Amir H Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas; Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston, Texas
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Covell MM, Rumalla KC, Bhalla S, Bowers CA. Risk analysis index predicts mortality and non-home discharge following posterior lumbar interbody fusion: a nationwide inpatient sample analysis of 429,380 patients (2019-2020). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08373-9. [PMID: 38902536 DOI: 10.1007/s00586-024-08373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/18/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Frailty is an independent risk factor for adverse postoperative outcomes following spine surgery. The ability of the Risk Analysis Index (RAI) to predict adverse outcomes following posterior lumbar interbody fusion (PLIF) has not been studied extensively and may improve preoperative risk stratification. METHODS Patients undergoing PLIF were queried from Nationwide Inpatient Sample (NIS) (2019-2020). The relationship between RAI-measured preoperative frailty and primary outcomes (mortality, non-home discharge (NHD)) and secondary outcomes (extended length of stay (eLOS), complication rates) was assessed via multivariate analyses. The discriminatory accuracy of the RAI for primary outcomes was measured in area under the receiver operating characteristic (AUROC) curve analysis. RESULTS A total of 429,380 PLIF patients (mean age = 61y) were identified, with frailty cohorts stratified by standard RAI convention: 0-20 "robust" (R)(38.3%), 21-30 "normal" (N)(54.3%), 31-40 "frail" (F)(6.1%) and 41+ "very frail" (VF)(1.3%). The incidence of primary and secondary outcomes increased as frailty thresholds increased: mortality (R 0.1%, N 0.1%, F 0.4%, VF 1.3%; p < 0.001), NHD (R 6.5%, N 18.1%, F 36.9%, VF 42.0%; p < 0.001), eLOS (R 18.0%, N 21.9%, F 31.6%, VF 43.8%; p < 0.001) and complication rates (R 6.6%, N 8.8%, F 11.1%, VF 12.2%; p < 0.001). The RAI demonstrated acceptable discrimination for NHD (C-statistic: 0.706) and mortality (C-statistic: 0.676) in AUROC curve analysis. CONCLUSION Increasing RAI-measured frailty is significantly associated with increased NHD, eLOS, complication rates, and mortality following PLIF. The RAI demonstrates acceptable discrimination for predicting NHD and mortality, and may be used to improve frailty-based risk assessment for spine surgeons.
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Affiliation(s)
| | - Kranti C Rumalla
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shubhang Bhalla
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 8342 S Levine Ln, Sandy, UT, 87122, USA.
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Connors C, Wang D, Levy M, Ravivarapu KT, Chin CP, Arroyave JS, Omidele O, Larenas F, Palese M. Transurethral Resection of Bladder Tumor Outcomes Are Predicted by a 5-Item Frailty Index. Urology 2024; 188:104-110. [PMID: 38522634 DOI: 10.1016/j.urology.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/15/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To evaluate the mFI-5 as a predictor of postoperative outcomes following transurethral resection of bladder tumor (TURBT). METHODS The National Surgical Quality Improvement Program database was queried for TURBT cases from 2015-2019. mFI-5 scores were calculated by assigning a point to chronic obstructive pulmonary disease, congestive heart failure, dependent functional status, hypertension, and diabetes. Patients were stratified by mFI-5 scores. Demographics and 30-day outcomes including Clavien-Dindo (CD) complications, mortality, and increased healthcare resource utilization (HCRU) were compared. HCRU outcomes included prolonged length of stay, unplanned readmission, and discharge to continued care. Multivariate regression assessed the predictive value of mFI-5 scores on outcomes. RESULTS 40,278 TURBT cases were identified (mFI-5 =0: 12,400, mFI-5 =1: 17,328, mFI-5 =2: 9225, mFI-5 ≥3: 1416). Patients with higher mFI-5 scores were more likely to be older, male, White, and have larger tumors, all P < .05. Increasing mFI-5 scores resulted in increased frequency of all adverse outcomes, all P < .001. On multivariate analysis, mFI-5 ≥ 3 classification was a predictor of CD I/II (OR=1.280), CD IV (OR=2.539), mortality (OR=2.202), HCRU (OR=2.094), prolonged length of stay (OR=2.136), discharge to continued care (OR=3.401), and unplanned readmission (OR=1.705), all P < .05. A mFI-5 ≥ 3 demonstrated a sensitivity ranging from 6.0%-13.5% and a specificity ranging from 96.6%-97.0% for all outcomes. CONCLUSION The mFI-5 is an easily ascertainable preoperative risk assessment tool that is a predictor of adverse clinical and HCRU outcomes following TURBT.
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Affiliation(s)
- Christopher Connors
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Daniel Wang
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Micah Levy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Chih Peng Chin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Olamide Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Francisca Larenas
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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11
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Chung MS, Patel N, Abdelmalek G, Coban D, Changoor S, Elali F, Sinha K, Hwang K, Emami A. The 5-factor modified frailty index (mFI-5) predicts adverse outcomes after elective anterior cervical discectomy and fusion (ACDF). NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100318. [PMID: 38618000 PMCID: PMC11015525 DOI: 10.1016/j.xnsj.2024.100318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/16/2024]
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is a reliable procedure commonly performed in older patients with degenerative diseases of the cervical spine. Over 130,000 procedures are performed every year with an annual increase of 5%, and overall morbidity rates can reach as high as 19.3%, indicating a need for surgeons to gauge their patients' risk for adverse outcomes. Frailty is an age-associated decline in functioning of multiple organ systems and has been shown to predict adverse outcomes following various spine procedures. There have been several proposed frailty indices of various factors including the 11-factor modified frailty index (mFI-11), which has been shown to be an effective tool for predicting complications in patients undergoing ACDF. However, there is a paucity of literature assessing the utility of the 5-factor modified frailty index (mFI-5) as a risk stratification tool for patients undergoing ACDF. The purpose of this study was to analyze the predictive capability of the mFI-5 score for 30-day postoperative adverse events following elective ACDF. Methods A retrospective review was performed using the National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2019. Patients older than 50 years of age who underwent elective ACDF were identified using Current Procedural Terminology ([CPT] codes 22554, 22551, 22552, and 63075). Exclusion criteria removed patients under the age of 51, as well as those with fractures, sepsis, disseminated cancer, a prior operation in the last 30 days, ascites, wound infection, or an emergency surgery. Patients were grouped using mFI scores of 1, 2, and 3+. Univariate analysis, using chi-squared and one-way analysis of variance (ANOVA) tests, was conducted to compare demographics, comorbidities, and postoperative complications across the varying cohorts based on mFI-5 scores. Multivariate logistic regression, including patient demographics and preoperative comorbidities as covariates, was performed to evaluate if mFI-5 scores were independent predictors of 30-day postoperative adverse events. Covariates including race, BMI, sex, ASA, and comorbidities were included in regression models. Results The 45,991 patients were identified and allocated in cohorts based on mFI-5 score. Rates for superficial surgical site infection (SSI), organ/deep space SSI, pneumonia, progressive renal insufficiency, acute renal failure (ARF), urinary tract infection (UTI), stroke/cardiovascular accident (CVA), cardiac arrest requiring cardiopulmonary resuscitation (CPR), myocardial infarction, bleeding requiring transfusions, deep vein thrombosis/thrombophlebitis, sepsis, septic shock, readmissions, reoperation, and mortality incrementally increased with mFI-5 scores from 0 to 3+. Multivariate regression analysis revealed that mFI-5 scores 1 to 3+ increased the odds, in a stepwise manner, of total complications, cardiac arrest requiring CPR, pneumonia and mortality. MFI-5 scores of 2 and 3+ were independent predictors of readmission (2: OR=1.5, p<.001; 3+: OR=2.0, p<.001) and myocardial infarction (2: OR=3.4, p=.001; 3+: OR=6.9, p<.001). A score of 3+ increased the odds of ARF (OR=9.7, p=.022), septic shock (OR=3.6, p=.036), UTI (OR=2.1, p=.007), bleeding requiring transfusions (OR=2.1, p=.016), and reoperations (OR=1.7, p=.004). Conclusion mFI-5 score is a quick and viable option for surgeons to use as an assessment tool to stratify high risk patients undergoing elective ACDF, as increasing mFI-5 scores showed significantly higher rates of all adverse outcomes accounted for in this study, except for deep incisional SSI, wound disruption, and PE. Additionally, moderate to severe mFI-5 scores of 2 or 3+ were independent predictors for 30-day postoperative ARF, UTI, MI, bleeding requiring transfusions, septic shock, reoperation, and readmissions following elective ACDF surgery in adults over 50 years old.
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Affiliation(s)
- Matthew S. Chung
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Neil Patel
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - George Abdelmalek
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Daniel Coban
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Stuart Changoor
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Faisal Elali
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Ki Hwang
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Arash Emami
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
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Bernuth S, Panayi AC, Didzun O, Knoedler S, Matar D, Bigdeli AK, Falkner F, Kneser U, Orgill DP, Jakubietz RG, Hundeshagen G. A nomogram for predicting outcomes following pedicled flap reconstruction of the lower extremity. J Plast Reconstr Aesthet Surg 2024; 96:13-22. [PMID: 39013259 DOI: 10.1016/j.bjps.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/05/2024] [Accepted: 05/24/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Lower extremity reconstructions with soft tissue flaps account for a significant proportion of reconstructive surgery. Pedicled flaps are a procedure of choice, particularly in multimorbid patients and those with small to medium-sized defects. Complication rates are high and should not be underestimated, with accurate preoperative risk factor assessment being imperative. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program Database (2008-2021), we analyzed all patients who underwent pedicled flap reconstruction of the lower extremity. Demographic data, comorbidities, and perioperative data were extracted. We identified risk factors of major surgical complications within 30 days of surgery through uni- and multivariate regression analyses. On this basis, a nomogram for predicting the risk of complications was developed to allow for feasible point-of-care risk assessment. RESULTS A total of 6475 adult patients were identified. The most common comorbidities were hypertension (n = 3363, 51.9%) and obesity (n = 2306, 35.6%) and most common American Society of Anesthesiologists (ASA) class was class 3 (n = 3703, 57.2%). The most common complication was bleeding/transfusion (n = 1293, 19.9%). Multivariate regression revealed longer procedures, inpatient setting, higher ASA scores, hypertension, and procedures performed by orthopedic and vascular surgeons as predictors for higher risk of post-operative complications. CONCLUSION Leveraging a risk- and case-mix-adjusted multi-institutional database, a nomogram for post-operative surgical complications within 30 days after pedicled flap reconstruction in the lower extremity was developed. This broadly applicable risk prediction tool can aid in decision-making when assessing patient eligibility.
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Affiliation(s)
- Silvia Bernuth
- Department of Plastic and Reconstructive Surgery, Clinic of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Oliver Didzun
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dany Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafael G Jakubietz
- Department of Plastic and Reconstructive Surgery, Clinic of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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Tasaka S, Kohada Y, Ikeda M, Kanaoka R, Hayashi M, Hinata N. Utility of the modified 5-item frailty index as a predictor of postoperative febrile urinary tract infection in patients who underwent ureteroscopy with laser lithotripsy. World J Urol 2024; 42:323. [PMID: 38748255 PMCID: PMC11096205 DOI: 10.1007/s00345-024-05016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE This study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones. METHODS Patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups. RESULTS Seventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8 °C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38 °C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups. CONCLUSION The modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.
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Affiliation(s)
- Shinsaku Tasaka
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuki Kohada
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Mikio Ikeda
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
| | - Ryuhei Kanaoka
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
| | - Mutsuo Hayashi
- Department of Urology, Takanobashi Central Hospital, Hiroshima, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Madelar RTR, Oe S, Yamato Y, Hasegawa T, Yoshida G, Banno T, Arima H, Ide K, Yamada T, Kurosu K, Nakai K, Matsuyama Y. 5-year outcomes of surgical intervention in patients with adult spine deformity according to preoperative 5-item modified frailty index scores. Spine Deform 2024; 12:763-774. [PMID: 38367170 DOI: 10.1007/s43390-024-00823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/06/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE Frailty increases vulnerability to dependency and/or death, and is important in predicting the risk for adverse effects following adult spinal deformity (ASD) surgery. For easy determination of frailty, the 5-item modified frailty index (mFI-5) was established. However, there are few reports that show the relationship between frailty and mid-term operative outcomes after ASD surgery. The objective of this retrospective study is to determine the correlation of frailty using mFi-5 scores with postoperative medical complications, patient reported outcome measures (PROMs), and radiographic alignment 5 years after ASD surgery. METHODS 208 patients were divided into robust (R), pre-frail (PF), and frail (F) groups based on mFI-5 scores. Postoperative medical complications, preoperative and 5-year follow-up PROMs and radiographic alignment were evaluated. RESULTS The study included 91, 79, and 38 patients in group R, PF, and F, respectively. There was no significant difference in age and sex. Discharge to care facility (16 (18%):21 (27%):16 (42%), p = 0.014) and postoperative cardiac complications (2 (2%):0 (0%):3 (8%), p = 0.031) were higher in frail patients. Preoperative ODI (38.3:45.3:54.7, p < 0.001) and SRS-22 (2.7:2.5:2.3, p = 0.004), 5-year postoperative ODI (27:27.2:37.9, p = 0.015), 5-year postoperative SVA (57.8°:78.5°:86.4°, p = 0.039) and 5-year postoperative TPA (23.9°:29.4°:29.5°, p = 0.011) were significantly worse in group F compared to group R. CONCLUSION Postoperatively, frail patients are more likely to have cardiac complications, inferior PROMs and deterioration of post-correction global spinal alignment. Preoperative assessment using mFI-5 is beneficial to individualize risks, optimize patients, and manage postoperative expectations. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Rina Therese R Madelar
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
- Department of Orthopedics, The Medical City, Ortigas Avenue, Pasig City, Philippines.
| | - Shin Oe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kenta Kurosu
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Keiichi Nakai
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Ibelli TJ, Alerte E, Akhavan A, Liu H, Kuruvilla A, Katz A, Etigunta S, Taub PJ. The Modified Five-Item Frailty Index to Predict Hand and Wrist Surgical Repair Postoperative Outcomes: An ACS-NSQIP Analysis of 11 369 Patients. Hand (N Y) 2024; 19:433-441. [PMID: 36194006 PMCID: PMC11067845 DOI: 10.1177/15589447221124270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hand and wrist injuries can cause painful, everyday obstacles for patients. Carefully indexing preoperative patient health conditions may better inform surgical care, leading to improved postoperative outcomes. The purpose of the present study is to evaluate if the Modified Five-Item Frailty Index (mFI-5) can accurately predict postoperative complications for hand and wrist surgical repair. METHODS A retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program database was conducted to investigate patients who underwent hand and wrist surgical repair from January 2013 to December 2019. Patient demographics, comorbidities, surgical logistics, and 30-day readmission due to postoperative complications were extracted. Surgical risk proxies including the mFI-5, age, body mass index (BMI), smoking status within 1 year, the Modified Charlson Comorbidity Index (mCCI), comorbidities, and American Society of Anaesthesiologists Physical Status Classification (ASA class) were calculated. RESULTS A total of 11 369 patients were included. Thirty-day readmission for total postoperative complications (n = 258) was significantly associated with all surgical risk proxies. However, age, mFI-5 > 2, mCCI > 2, comorbidities > 1, and ASA class 2/3 had the highest statistical significance (P = <.001). Thirty-day readmission rates for surgical site infections (n = 118) had the highest statistical significance with age, BMI, mFI-5 > 2, and ASA class 2/3 (P = <.001). A Clavien-Dindo score > 1 (n = 224) had the highest statistical significance with age, mCCI > 2, comorbidity of 1, and an ASA class 3 (P = <.001). CONCLUSIONS The mFI-5 may have value in predicting 30-day readmission due to postoperative complications after surgical repair of hand and wrist injuries.
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Affiliation(s)
| | - Eric Alerte
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Helen Liu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Abigail Katz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhas Etigunta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter J. Taub
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hernández-Aguiar Y, Becerra-Bolaños Á, Rodríguez-Pérez A. Preoperative diagnosis of frailty. J Int Med Res 2024; 52:3000605241251705. [PMID: 38818532 PMCID: PMC11143825 DOI: 10.1177/03000605241251705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 06/01/2024] Open
Abstract
The aging world population obliges physicians to establish measures to optimize and estimate the outcomes of increasingly frail patients. Thus, in the last few years there has been an increase in the application of frailty indices. Multiple scales have emerged that can be applied in the perioperative setting. Each one has demonstrated some utility, either by way of establishing postoperative prognosis or as a method for the clinical optimization of patient care. Anaesthesiologists are offered a wide choice of scales, the characteristics and appropriate management of which they are often unaware. This narrative review aims to clarify the concept of frailty, describe its importance in the perioperative setting and evaluate the different scales that are most applicable to the perioperative setting. It will also establish paths for the future optimization of patient care.
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Affiliation(s)
- Yanira Hernández-Aguiar
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ángel Becerra-Bolaños
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Aurelio Rodríguez-Pérez
- Department of Anaesthesiology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Coimbra R, Kim M, Allison-Aipa T, Zakhary B, Kwon J, Firek M, Coimbra BC, Costantini TW, Haynes LN, Edwards SB. Deaths After Readmissions are Mostly Attributable to Failure-to-Rescue in EGS Patients. Am Surg 2024:31348241248796. [PMID: 38656140 DOI: 10.1177/00031348241248796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION We have recently shown that readmission after EGS procedures carries a 4-fold higher mortality rate when compared to those not readmitted. Understanding factors associated with death after readmission is paramount to improving outcomes for EGS patients. We aimed to identify risk factors contributing to failure-to-rescue (FTR) during readmission after EGS. We hypothesized that most post-readmission deaths in EGS are attributable to FTR. METHODS A retrospective cohort study using the NSQIP database 2013-2019 was performed. Patients who underwent 1 of 9 urgent/emergent surgical procedures representing 80% of EGS burden of disease, who were readmitted within 30 days post-procedure were identified. The procedures were classified as low- and high-risk. Patient characteristics analyzed included age, sex, BMI, ASA score comorbidities, postoperative complications, frailty, and FTR. The population was assessed for risk factors associated with mortality and FTR by uni- and multivariate logistic regression. RESULTS Of 312,862 EGS cases, 16,306 required readmission. Of those, 10,748 (3.4%) developed a postoperative complication. Overall mortality after readmission was 2.4%, with 90.6% of deaths attributable to FTR. Frailty, high-risk procedures, pulmonary complications, AKI, sepsis, and the need for reoperation increased the risk of FTR. DISCUSSION Death after a complication is common in EGS readmissions. The impact of FTR could be minimized with the implementation of measures to allow early identification and intervention or prevention of infectious, respiratory, and renal complications.
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Affiliation(s)
- Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Department of Surgery, University of California Riverside, Moreno Valley, CA, USA
| | - Maru Kim
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Bishoy Zakhary
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Junsik Kwon
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- Department of Trauma Surgery, Ajou University School of Medicine, Seoul, Republic of Korea
| | - Matthew Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
| | - Bruno Cammarota Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Laura N Haynes
- Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Sara B Edwards
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Department of Surgery, University of California Riverside, Moreno Valley, CA, USA
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Jain A, Goldberg ZN, Briggs E, Amin DR, Urdang ZD, Goldman RA, Cognetti DM, Curry JM. Modified Frailty Index Associates With Transoral Robotic Surgery Complications and Survival: A National Database Study. Laryngoscope 2024. [PMID: 38651382 DOI: 10.1002/lary.31458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The modified frailty index (mFI-5) is a National Surgical Quality Improvement Program-derived 5-factor index that has been proven to reflect frailty and predict morbidity and mortality. We hypothesize that mFI-5 is a valid predictive measure in the transoral robotic surgery (TORS) population. METHODS Retrospective study utilizing the TriNetX US-collaborative health records network querying for TORS patients. Cohorts were stratified by mFI-5 score which uses five ICD-10 codes: nonindependent functional status, hypertension, obstructive respiratory disease, heart failure, and diabetes mellitus. Cohorts were matched by age using propensity score matching. Outcome measures included survival, infection, pneumonia, tracheostomy dependence, and percutaneous endoscopic gastrostomy dependence. Reported odds ratios were normalized to mFI-5 = 0. RESULTS A total of 9,081 patients were included in the final analysis. Greater mFI-5 scores predicted decreased survival and increased incidence of postoperative infection and pneumonia. Odds of 5-year mortality were 1.93 (p = 0.0003) for mFI-5 = 2 and 1.90 (p = 0.0002) for mFI-5 = 3. Odds of 2-year mortality were 1.25 (p = 0.0125) for mFI-5 = 1, 1.58 (p = 0.0002) for mFI-5 = 2, and 1.87 (p = 0.003) for mFI-5 = 3. Odds of postoperative infection were 1.51 (p = 0.02) for mFI-5 = 2 and 1.78 (p = 0.05) for mFI-5 = 3. Two-year odds of developing pneumonia were 1.69 (p = 0.0001) for mFI-5 = 2 and 2.84 (p < 0.0001) for mFI-5 = 3. Two-month odds of pneumonia were 1.50 (p = 0.0259) for mFI-5 = 2 and 2.55 (p = 0.0037) for mFI-5 = 3. mFI-5 = 4 or 5 had too few patients to analyze. Using polynomial regression to model age versus incident 5-year post-TORS death (R2 = 0.99), mFI-5 scores better predicted survival than age alone. CONCLUSION This study demonstrates that mFI-5 predicts mortality, pneumonia, and postoperative infection independently of age. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Amiti Jain
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Zachary N Goldberg
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Erin Briggs
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Dev R Amin
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Zachary D Urdang
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Richard A Goldman
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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19
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Adebola O. Do we need a neurosurgical frailty index? Surg Neurol Int 2024; 15:134. [PMID: 38742014 PMCID: PMC11090588 DOI: 10.25259/sni_50_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/06/2024] [Indexed: 05/16/2024] Open
Abstract
Background An increasing number of elderly patients now require neurosurgical intervention, and it is sometimes unclear if the benefits of surgery outweigh the risks, especially considering the confounding factor of numerous comorbidities and often poor functional states. Historically, many patients were denied surgery on the basis of age alone. This paper examines the current selection criteria being used to determine which patients get offered neurosurgical management and attempts to show if these patients have a good outcome. Particular focus is given to the increasing insight into the need to develop a neurosurgical frailty index. Methods Using a prospective cohort study, this study observed 324 consecutive patients (n) over a 3-month period who were ≥65 years of age at the time of referral or admission to the neurosurgical department of the Royal Hallamshire Hospital. It highlights the selection model used to determine if surgical intervention was in the patient's best interest and explores the reasons why some patients did not need to have surgery or were considered unsuitable for surgery. Strengths and weaknesses of different frailty indices and indicators of functional status currently in use are discussed, and how they differ between the patients who had surgery and those who did not. Results Sixty-one (18.83%) of n were operated on in the timeframe studied. Compared to patients not operated, they were younger, less frail, and more functionally independent. The 30-day mortality of patients who had surgery was 3.28%, and despite the stringent definition of poor outcomes, 65.57% of patients had good postoperative results overall, suggesting that the present selection model for surgery produces good outcomes. The independent variables that showed the greatest correlation with outcome were emergency surgery, the American Society of Anesthesiology grade, the Glasgow Coma Scale, and modified frailty index-5. Conclusion It would be ideal to carry out future studies of similar designs with a much larger sample size with the goal of improving existing selection criteria and possibly developing a neurosurgical frailty index.
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Affiliation(s)
- Oluwaseyi Adebola
- Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom
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20
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Barton E, Verduri A, Carter B, Hughes J, Hewitt J, Maskell NA. The association between frailty and survival in patients with pleural disease: a retrospective cohort study. BMC Pulm Med 2024; 24:180. [PMID: 38627673 PMCID: PMC11020337 DOI: 10.1186/s12890-024-02981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frailty status in patients with pleural disease. METHODS In this retrospective analysis of a prospectively collected observational cohort study, outpatients presenting to the pleural service at a tertiary centre in Bristol, UK with a radiologically confirmed, undiagnosed pleural effusion underwent comprehensive assessment and were assigned a final diagnosis at 12 months. The modified frailty index (mFI) was calculated and participants classified as frail (mFI ≥ 0.4) or not frail (mFI ≤ 0.2). RESULTS 676 participants were included from 3rd March 2008 to 29th December 2020. The median time to mortality was 490 days (IQR 161-1595). A positive association was found between 12-month mortality and frailty (aHR = 1.72, 95% CI 1.02-2.76, p = 0.025) and age ≥ 80 (aHR = 1.80, 95% CI 1.24-2.62, p = 0.002). Subgroup analyses found a stronger association between 12-month mortality and frailty in benign disease (aHR = 4.36, 95% CI 2.17-8.77, p < 0.0001) than in all pleural disease. Malignancy irrespective of frailty status was associated with an increase in all-cause mortality (aHR = 10.40, 95% CI 6.01-18.01, p < 0.0001). CONCLUSION This is the first study evaluating the relationship between frailty and outcomes in pleural disease. Our data demonstrates a strong association between frailty and 12-month mortality in this cohort. A malignant diagnosis is an independent predictor of 12-month mortality, irrespective of frailty status. Frailty was also strongly associated with 12-month mortality in patients with a benign underlying cause for their pleural disease. This has clinical relevance for pleural physicians; evaluating patients' frailty status and its impact on mortality can guide clinicians in assessing suitability for invasive investigation and management. TRIAL REGISTRATION This study is registered with the Health Research Authority (REC reference 08/H0102/11) and the NIHR Portfolio (Study ID 8960).
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Affiliation(s)
- Eleanor Barton
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
| | - A Verduri
- Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Policlinico Modena, Italy
| | - B Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Department of Population Medicine, Cardiff University, Cardiff, UK
| | - J Hughes
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - J Hewitt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - N A Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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21
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Fenton D, Allen A, Kent JR, Nordgren R, Liu A, Rama N, Wang A, Rubin D, Gleason LJ, Justine Landi A, Huisingh-Scheetz M, Ferguson MK, Madariaga MLL. The association between neighborhood disadvantage and frailty: A retrospective case series. J Public Health Res 2024; 13:22799036241258876. [PMID: 38867913 PMCID: PMC11168058 DOI: 10.1177/22799036241258876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 05/16/2024] [Indexed: 06/14/2024] Open
Abstract
Background Frailty predicts poorer outcomes in surgical patients. Recent studies have found socioeconomic status to be an important characteristic for surgical outcomes. We evaluated the association of Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), two geospatial atlases that provide a multidimensional evaluation of neighborhood deprivation, with frailty in a surgery population. Design & methods A retrospective study of patients undergoing routine frailty screening was conducted 12/2020-8/2022. Frailty was measured using Fried's Frailty Phenotype (FFP) and the five-item Modified Frailty Index (mFI-5). ADI and SVI quartiles were determined using patient residence. Logistic regression models were used to evaluated associations of FFP (frail only vs not frail) and mFI-5 (≥2 vs 0-1) with ADI and SVI (α = 0.05). Results Of 372 screened patients, 41% (154) were women, median age was 68% (63-74), and 46% (170) identified as non-White. Across ADI and SVI quartiles, higher number of comorbidities, decreasing median income, and frailty were associated with increasing deprivation (p < 0.01). When controlling for age, sex, comorbidities, and BMI category, frailty by FFP was associated with the most deprived two quartiles of ADI (OR 2.61, CI: [1.35-5.03], p < 0.01) and the most deprived quartile of SVI (OR 2.33, [1.10-4.95], p < 0.05). These trends were also seen with mFI-5 scores ≥2 (ADI: OR 1.64, [1.02-2.63], p < 0.05; SVI: OR 1.71, [1.01-2.91], p < 0.05). Conclusions Surgical patients living in socioeconomically deprived neighborhoods are more likely to be frail. Interventions may include screening of disadvantaged populations and resource allocation to vulnerable neighborhoods.
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Affiliation(s)
- David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Amani Allen
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Johnathan R Kent
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Allison Liu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Nihar Rama
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ally Wang
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Daniel Rubin
- Department of Anesthesia & Critical Care, University of Chicago Medicine, Chicago, IL, USA
| | - Lauren J Gleason
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - A Justine Landi
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Mark K Ferguson
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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22
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Camino-Willhuber G, Choi J, Holc F, Oyadomari S, Guiroy A, Bow H, Hashmi S, Oh M, Bhatia N, Lee YP. Utility of the Modified 5-Items Frailty Index to Predict Complications and Mortality After Elective Cervical, Thoracic and Lumbar Posterior Spine Fusion Surgery: Multicentric Analysis From ACS-NSQIP Database. Global Spine J 2024; 14:839-845. [PMID: 36050879 PMCID: PMC11192117 DOI: 10.1177/21925682221124101] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review of multicentric data. OBJECTIVES The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. It has been recently shown a good predictive value after posterior lumbar fusion. We aimed to compare the predictive value of the modified 5-item frailty index in cervical, thoracic and lumbar surgery. METHODS The American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) Database 2015-2020 was used to identify patients who underwent elective posterior cervical, thoracic, or lumbar fusion surgeries for degenerative conditions. The mFI-5 score was calculated based on the presence of 5 co-morbidities: congestive heart failure within 30 days prior to surgery, insulin-dependent or noninsulin-dependent diabetes mellitus, chronic obstructive pulmonary disease or pneumonia, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Multivariate analysis was used to assess the independent impact of increasing mFI-5 score on the postoperative morbidity while controlling for baseline clinical characteristics. RESULTS 53 252 patients were included with the mean age of 64.2 ± 7.2. 7946 suffered medical complications (14.9%), 1565 had surgical complications (2.9%), and 3385 were readmitted (6.3%), 363 died (.68%) within 30 days postoperative (6.3%). The mFI-5 items score was significantly associated with higher rates of complications, readmission, and mortality in cervical, thoracic, and lumbar posterior fusion surgery. CONCLUSION The modified 5-item frailty score is a reliable tool to predict complications, readmission, and mortality in patients planned for elective posterior spinal fusion surgery.
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Affiliation(s)
- Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Jeffrey Choi
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Fernando Holc
- Orthopaedic and Traumatology Department, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sarah Oyadomari
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Alfredo Guiroy
- Elite Spine Health and Wellness Center, Fort Lauderdale, FL, USA
| | - Hansen Bow
- Department of Neurosurgery, University of California Irvine, Orange, CA, USA
| | - Sohaib Hashmi
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Michael Oh
- Department of Neurosurgery, University of California Irvine, Orange, CA, USA
| | - Nitin Bhatia
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Yu-Po Lee
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
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23
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Gutierrez RD, Smith EJT, Matthay ZA, Gasper WJ, Hiramoto JS, Conte MS, Finlayson E, Walter LC, Iannuzzi JC. Risk factors and associated outcomes of postoperative delirium after open abdominal aortic aneurysm repair. J Vasc Surg 2024; 79:793-800. [PMID: 38042511 DOI: 10.1016/j.jvs.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVE Open abdominal aortic aneurysm repair (OAR) is a major vascular procedure that incurs a large physiologic demand, increasing the risk for complications such as postoperative delirium (POD). We sought to characterize POD incidence, identify delirium risk factors, and evaluate the effect of delirium on postoperative outcomes. We hypothesized that POD following OAR would be associated with increased postoperative complications and resource utilization. METHODS This was a retrospective study of all OAR cases from 2012 to 2020 at a single tertiary care center. POD was identified via a validated chart review method based on key words and Confusion Assessment Method assessments. The primary outcome was POD, and secondary outcomes included length of stay, non-home discharge, 90-day mortality, and 1-year survival. Bivariate analysis as appropriate to the data was used to assess the association of delirium with postoperative outcomes. Multivariable binary logistic regression was used to identify risk factors for POD and Cox regression for variables associated with worse 1-year survival. RESULTS Overall, 198 OAR cases were included, and POD developed in 34% (n = 67). Factors associated with POD included older age (74 vs 69 years; P < .01), frailty (50% vs 28%; P < .01), preoperative dementia (100% vs 32%; P < .01), symptomatic presentation (47% vs 27%; P < .01), preoperative coronary artery disease (44% vs 28%; P = .02), end-stage renal disease (89% vs 32%; P < .01) and Charlson Comorbidity Index score >4 (42% vs 26%; P = .01). POD was associated with 90-day mortality (19% vs 5%; P < .01), non-home discharge (61% vs 30%; P < .01), longer median hospital length of stay (14 vs 8 days; P < .01), longer median intensive care unit length of stay (6 vs 3 days; P < .01), postoperative myocardial infarction (7% vs 2%; P = .045), and postoperative pneumonia (19% vs 8%; P = .01). On multivariable analysis, risk factors for POD included older age, history of end-stage renal disease, lack of epidural, frailty, and symptomatic presentation. A Cox proportional hazards model revealed that POD was associated with worse survival at 1 year (hazard ratio, 3.8; 95% confidence interval, 1.6-9.0; P = .003). CONCLUSIONS POD is associated with worse postoperative outcomes and increased resource utilization. Future studies should examine the role of improved screening, implementation of delirium prevention bundles, and multidisciplinary care for the most vulnerable patients undergoing OAR.
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Affiliation(s)
- Richard D Gutierrez
- Department of Surgery, University of California, San Francisco, San Francisco, CA.
| | - Eric J T Smith
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Zachary A Matthay
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Jade S Hiramoto
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Michael S Conte
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Louise C Walter
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - James C Iannuzzi
- Department of Surgery, University of California, San Francisco, San Francisco, CA
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24
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Li R, Sidawy A, Nguyen BN. The 5-Factor Modified Frailty Index is a Concise and Effective Predictor of 30-Day Adverse Outcomes in Carotid Endarterectomy. J Surg Res 2024; 296:507-515. [PMID: 38330676 DOI: 10.1016/j.jss.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/29/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Frailty is a clinically identifiable condition characterized by heightened vulnerability. The 5-item Modified Frailty Index provides a concise calculation of frailty that has proven effective in predicting adverse perioperative outcomes across a variety of surgical disciplines. However, there is a paucity of research examining the validity of 11-item Modified Frailty Index (mFI-5) in carotid endarterectomy (CEA). This study aimed to investigate the association between mFI-5 and 30-day outcomes of CEA. METHODS Patients underwent CEA were identified from American College of Surgeons National Surgical Quality Improvement Program targeted database from 2012 to 2021. Patients with age<18 were excluded. Patients were stratified into four cohorts based on their mFI-5 scores: 0, 1, 2, or 3+. Multivariable logistic regression was used to compare 30-day perioperative outcomes adjusting for preoperative variables with P value<0.1. RESULTS Compared to controls (mFI-5 = 0), patients mFI-5 = 1 had higher risk of stroke (adjusted odds ratio [aOR] = 1.333, P = 0.02), unplanned operation (aOR = 1.38, P < 0.01), and length of stay (LOS) > 7 days (aOR = 0.814, P < 0.01). Patients with mFI-5 = 2 had higher stroke (aOR = 1.719, P < 0.01), major adverse cardiovascular events (MACE) (aOR = 1.315, P = 0.01), sepsis (aOR = 2.243, P = 0.01), discharge not to home (aOR = 1.200, P < 0.01), 30-day readmission (aOR = 1.405, P < 0.01). Compared with controls, patients with mFI-5≥3 had higher mortality (aOR = 1.997 P = 0.02), MACE (aOR = 1.445, P = 0.03), cardiac complications (aOR = 1.901, P < 0.01), pulmonary events (aOR = 2.196, P < 0.01), sepsis (aOR = 3.65, P < 0.01), restenosis (aOR = 2.606, P = 0.02), unplanned operation (aOR = 1.69, P < 0.01), LOS>7 days (aOR = 1.425, P < 0.01), discharge not to home (aOR = 2.127, P < 0.01), and 30-day readmission (aOR = 2.427, P < 0.01). CONCLUSIONS The mFI-5 is associated with 30-day mortality and complications including stroke, MACE, cardiac complications, pulmonary complications, sepsis, and restenosis. Additionally, elevated mFI-5 scores correlate with an increased likelihood of unplanned operations, extended LOS, discharge to facilities other than home, and 30-day readmissions, all of which could negatively impact long-term prognosis. Therefore, mFI-5 can serve as a concise yet effective metric of frailty in patients undergoing CEA.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia.
| | - Anton Sidawy
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - Bao-Ngoc Nguyen
- Division of Vascular Surgery, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia
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25
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Chaliparambil RK, Nandoliya KR, Jahromi BS, Potts MB. Charlson Comorbidity Index and Frailty as Predictors of Resolution Following Middle Meningeal Artery Embolization for Chronic Subdural Hematoma. World Neurosurg 2024; 183:e877-e885. [PMID: 38218440 DOI: 10.1016/j.wneu.2024.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Research on variables associated with chronic subdural hematoma (cSDH) resolution following middle meningeal artery embolization (MMAE) is limited. This study investigated the clinical utility of age-adjusted Charlson Comorbidity Index (ACCI) and modified 5-item Frailty Index (mFI - 5) for predicting cSDH resolution following MMAE. METHODS We identified patients who underwent MMAE at our institution between January 2018 and December 2022, with at least 20 days of follow-up and one radiographic follow-up study. Patient demographics, characteristics, and outcomes were collected. Complete resolution was defined as absence of subdural collections on CT-scan at last follow-up. Nonage adjusted CCI (CCI), ACCI, and mFI - 5 scores were calculated. Univariate and multivariable logistic regression analyzed the relationship between cSDH resolution and variables. A receiver operating characteristic (ROC) curve established the utility of ACCI and mFI - 5 in predicting hematoma resolution. RESULTS The study included 85 MMAE procedures. In univariate analysis, patients without resolution were older, had higher CCI, higher ACCI, higher mFI - 5, and were more likely to have diabetes mellitus. In multivarible analysis, CCI (OR: 0.66, 95% CI: 0.48, 0.91) was independently associated with resolution controlling for age and antithrombotic resumption. The area under the ROC (AUROC) curve was 0.75 (95% CI: 0.65-0.85) for ACCI and 0.64 (95% CI: 0.52-0.76) for mFI - 5. The optimal cutoffs for predicting resolution were ACCI ≥5 (sensitivity = 0.63, specificity = 0.77), and mFI - 5 > 0 (sensitivity = 0.84, specificity = 0.43). CONCLUSIONS ACCI and mFI - 5 moderately predict MMAE resolution and may aid in medical decision-making.
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Affiliation(s)
- Rahul K Chaliparambil
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Khizar R Nandoliya
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Babak S Jahromi
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Ken and Ruth Davee Department of Neurology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew B Potts
- Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Ken and Ruth Davee Department of Neurology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Kweh BTS, Lee HQ, Tan T, Liew S, Hunn M, Wee Tee J. Posterior Instrumented Spinal Surgery Outcomes in the Elderly: A Comparison of the 5-Item and 11-Item Modified Frailty Indices. Global Spine J 2024; 14:593-602. [PMID: 35969642 PMCID: PMC10802518 DOI: 10.1177/21925682221117139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES To validate the most concise risk stratification system to date, the 5-item modified frailty index (mFI-5), and compare its effectiveness with the established 11-item modified frailty index (mFI-11) in the elderly population undergoing posterior instrumented spine surgery. METHODS A single centre retrospective review of posterior instrumented spine surgeries in patients aged 65 years and older was conducted. The primary outcome was rate of post-operative major complications (Clavien-Dindo Classification ≥ 4). Secondary outcome measures included rate of all complications, 6-month mortality and surgical site infection. Multi-variate analysis was performed and adjusted receiver operating characteristic curves were generated and compared by DeLong's test. The indices were correlated with Spearman's rho. RESULTS 272 cases were identified. The risk of major complications was independently associated with both the mFI-5 (OR 1.89, 95% CI 1.01-3.55, P = .047) and mFI-11 (OR 3.73, 95% CI 1.90-7.30, P = .000). Both the mFI-5 and mFI-11 were statistically significant predictors of risk of all complications (P = .007 and P = .003), surgical site infection (P = .011 and P = .003) and 6-month mortality (P = .031 and P = .000). Adjusted ROC curves determined statistically similar c-statistics for major complications (.68 vs .68, P = .64), all complications (.66 vs .64, P = .10), surgical site infection (.75 vs .75, P = .76) and 6-month mortality (.83 vs .81, P = .21). The 2 indices correlated very well with a Spearman's rho of .944. CONCLUSIONS The mFI-5 and mFI-11 are equally effective predictors of postoperative morbidity and mortality in this population. The brevity of the mFI-5 is advantageous in facilitating its daily clinical use.
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Affiliation(s)
- Barry T. S. Kweh
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Terence Tan
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
| | - Susan Liew
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of Orthopaedics, The Alfred Hospital, Melbourne, VIC, Australia
| | - Martin Hunn
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Orthopaedics, The Alfred Hospital, Melbourne, VIC, Australia
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Manzetti M, Ruffilli A, Viroli G, Traversari M, Ialuna M, Salamanna F, Neri S, Faldini C. Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature. Global Spine J 2024:21925682241235605. [PMID: 38382093 DOI: 10.1177/21925682241235605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
STUDY DESIGN Metanalysis. OBJECTIVE Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI. METHODS Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant. RESULTS 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11). CONCLUSION This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.
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Affiliation(s)
- Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Salamanna
- Surgical Science and Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
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Momtaz D, Okpara S, Martinez A, Cushing T, Ghali A, Gonuguntla R, Kotzur T, Duruewuru A, Harris M, Seifi A, Harrington M. A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty. ARTHROPLASTY 2024; 6:7. [PMID: 38310263 PMCID: PMC10838456 DOI: 10.1186/s42836-024-00232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION This study aimed to develop a modified frailty index (MFI) to predict the risks of revision total hip arthroplasty (THA). METHODS Data from the American College of Surgeons - National Surgical Quality Improvement Program were analyzed for patients who underwent revision THA from 2015 to 2020. An MFI was composed of the risk factors, including severe obesity (body mass index > 35), osteoporosis, non-independent function status prior to surgery, congestive heart failure within 30 days of surgery, hypoalbuminemia (serum albumin < 3.5), hypertension requiring medication, type 1 or type 2 diabetes, and a history of chronic obstructive pulmonary disease or pneumonia. The patients were assigned based on the MFI scores (MFI0, no risk factor; MFI1, 1-2 risk factors; MFI2, 3-4 risk factors; and MFI3, 5+ risk factors). Confidence intervals were set at 95% with a P value less than or equal to 0.05 considered statistically significant. RESULTS A total of 17,868 patients (45% male, 55% female) were included and had an average age of 68.5 ± 11.5 years. Odds of any complication, when compared to MFI0, were 1.4 (95% CI [1.3, 1.6]) times greater for MFI1, 3.2 (95% CI [2.8, 3.6]) times greater for MFI2, and 10.8 (95% CI [5.8, 20.0]) times greater for MFI3 (P < 0.001). Odds of readmission, when compared to MFI0, were 1.4 (95% CI [1.3, 1.7]) times greater for MFI1, 2.5 (95% CI [2.1, 3.0]) times greater for MFI2, and 4.1 (95% CI [2.2, 7.8]) times greater for MFI3 (P < 0.001). CONCLUSION Increasing MFI scores correlate with increased odds of complication and readmission in patients who have undergone revision THA. This MFI may be used to predict the risks after revision THA.
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Affiliation(s)
- David Momtaz
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Shawn Okpara
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Armando Martinez
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Tucker Cushing
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Rishi Gonuguntla
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Travis Kotzur
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Anthony Duruewuru
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Madison Harris
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ali Seifi
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Melvyn Harrington
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
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Vadhera AS, Sachdev R, Andrade NS, Ren M, Zhang B, Kebaish KM, Cohen DB, Skolasky RL, Neuman BJ. Predicting major complications and discharge disposition after adult spinal deformity surgery. Spine J 2024; 24:325-329. [PMID: 37844627 DOI: 10.1016/j.spinee.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/29/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND CONTEXT Several spine-specific comorbidity indices are available to help risk-stratify patients before they undergo invasive spine procedures. Studies of patients with adult spinal deformity (ASD) typically use the Charlson Comorbidity Index (CCI), which is not specific to spine patients. PURPOSE To compare the CCI with the Seattle Spine Score (SSS), the Adult Spinal Deformity-Comorbidity Score (ASD-CS), and the Modified 5-Item Frailty Index (mFI-5) and identify which tool more accurately predicted major perioperative complications and discharge disposition after ASD surgery. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Patients with ASD who underwent spinal arthrodesis of at least four levels at a single institution. OUTCOME MEASURES Self-reported measures include SSS, ASD-CS, and mFI-5. Functional measures include the CCI. METHODS We retrospectively reviewed records of 164 patients with ASD who underwent spinal arthrodesis of ≥ four levels from January 2008 to February 2018 at our U.S. academic tertiary care center and who had available Oswestry Disability Index values. To assess the predictive ability of the comorbidity indices, we created five multivariable logistic regression models, with the presence of major complications and discharge disposition (home or inpatient rehabilitation) as the primary outcome variables. The base model used validated demographic and surgical factors that were predictors of complications and outcomes in those with ASD and within the broader spinal literature. The other four models used the base model along with one of the four indices. The predictive ability of each model was compared using goodness-of-fit testing, with higher pseudo-R2 values and lower Akaike information criteria (AIC) values indicating better model fit. RESULTS Thirty-one patients (19%) experienced major perioperative complications, and 68 (42%) were discharged to inpatient rehabilitation facilities (vs home). The model using the SSS had the highest pseudo-R2 value and lowest AIC value for both major complications and discharge disposition. The mFI-5 had a similar predictive ability. The models using the CCI and ASD-CS were weaker predictors. CONCLUSIONS Compared with the CCI and the ASD-CS, the SSS and the mFI-5 were strong predictors of major complications and discharge disposition after ASD surgery. These results suggest that the SSS and the mFI-5 are preferable to the CCI for clinical risk stratification and outcomes research in patients undergoing ASD surgery.
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Affiliation(s)
- Amar S Vadhera
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Rahul Sachdev
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Nicholas S Andrade
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Mark Ren
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - David B Cohen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287.
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Khan M, Patnaik R, Lue M, Dao Campi H, Montorfano L, Sarmiento Cobos M, Valera RJ, Rosenthal RJ, Wexner SD. Modified Frailty Index Predicts Postoperative Complications Following Parastomal Hernia Repair. Am Surg 2024; 90:207-215. [PMID: 37632725 DOI: 10.1177/00031348231198102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
BACKGROUND The 5-factor frailty index (5-mFI), validated frailty index with Spearmen rho correlation of .95 and C statistic >.7 for predicting postoperative complications, can be preoperatively used to stratify patients prior to parastomal hernia repairs. METHODS Retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database identified patients from 2015 to 2020. 5-mFI scores were calculated by adding one point for each comorbidity present: diabetes mellitus, congestive heart failure (CHF), hypertension requiring medication, severe chronic obstructive pulmonary disease (COPD), non-independent functional status. Primary endpoint was 30-day overall complications; secondary endpoints were 30-day readmission, reoperation, and discharge to care facility. RESULTS 2924 (52.2% female) patients underwent elective parastomal hernia repair. Univariate analysis showed 5-mFI > 2 had higher rates of overall (P = .008), pulmonary (P = .002), cardiovascular (P = .003)), hematologic (P = .003), and renal (P = .002) complications and higher rates of readmission (P = .009), reoperation (P = .001), discharge to care facility (P < .001), and death (P < .001). Multivariate analysis identified a 5-mFI of 2 or more as an independent risk factor for overall complications [OR: 1.40, 1.03-1.78; P = .032], pulmonary complications [2.97, 1.63-5.39; P < .001], hematological complications [1.60, 1.03-2.47; P = .035], renal complications [2.04, 1.19-3.46; P = .009], readmission [1.54, 1.19-1.99; P < .001], and discharge to facility [2.50, 1.66-3.77; P < .001]. Reoperation was not signification on multivariate analysis. CONCLUSIONS Parastomal hernia repair patients with 5-mFI score of >2 had higher risk of renal, cardiovascular, pulmonary, and hematologic complications, readmissions, longer hospitalization, discharge to care facility, and mortality, and can be useful during preoperative risk stratification.
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Affiliation(s)
- Mustafa Khan
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ronit Patnaik
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Melinda Lue
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Haisar Dao Campi
- Department of General Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Lisandro Montorfano
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Roberto J Valera
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Raul J Rosenthal
- Department of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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Pedro KM, Alvi MA, Hejrati N, Moghaddamjou A, Fehlings MG. Elderly Patients Show Substantial Improvement in Health-Related Quality of Life After Surgery for Degenerative Cervical Myelopathy Despite Medical Frailty: An Ambispective Analysis of a Multicenter, International Data Set. Neurosurgery 2024:00006123-990000000-01016. [PMID: 38197642 DOI: 10.1227/neu.0000000000002818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/17/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We assessed the relationship between Modified Frailty Index-5 (mFI-5) and neurological outcomes, as well as health-related quality of life (HRQoL) measures, in elderly patients with degenerative cervical myelopathy (DCM) after surgery. METHODS Data from 3 major DCM trials (the Arbeitsgemeinschaft für Osteosynthesefragen Spine Cervical Spondylotic Myelopathy-North America, Cervical Spondylotic Myelopathy-International, and CSM-PROTECT studies) were combined, involving 1047 subjects with moderate to severe myelopathy. Patients older than 60 years with 6-month and 1-year postoperative data were analyzed. Neurological outcome was assessed using the modified Japanese Orthopaedic Association score, while HRQoL was measured using the 36-Item Short Form Health Survey (SF-36) (both Physical Component Summary [SF-36 PCS] and Mental Component Summary [SF-36 MCS] scores) and the Neck Disability Index. Frail (mFI ≥2) and nonfrail (mFI = 0-1) cohorts were compared using univariate paired statistics. RESULTS The final analysis included 261 patients (62.5% male), with a mean age of 71 years (95% CI 70.7-72). Frail patients (mFI ≥2) had lower baseline modified Japanese Orthopaedic Association scores (10.45 vs 11.96, P < .001), SF-36 PCS scores (32.01 vs 36.51, P < .001), and SF-36 MCS scores (39.32 vs 45.24, P < .001). At 6-month follow-up, SF-36 MCS improved by a mean (SD) of 7.19 (12.89) points in frail vs 2.91 (11.11) points in the nonfrail group (P = .016). At 1 year after surgery, frail patients showed greater improvement in both SF-36 PCS and SF-36 MCS composite scores compared with nonfrail patients (7.81 vs 4.49, P = .038, and 7.93 vs 3.01, P = .007, respectively). Bivariate regression analysis revealed that higher mFI-5 scores correlated with more substantial improvement in overall mental status at 6 months and 1 year (P = .024 and P = .009, respectively). CONCLUSION mFI-5 is a clinically helpful signature to reflect the HRQoL status among elderly patients with DCM. Despite preoperative medical frailty, elderly patients with DCM experience significant HRQoL improvement after surgery. These findings enable clinicians to identify elderly patients with modifiable comorbidities and provide informed counseling on anticipated outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Karlo M Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Ali Alvi
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nader Hejrati
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Ali Moghaddamjou
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Moniz-Garcia D, Odeh N, Genel O, Montaser A, Sousa-Pinto B, De Biase G, Otamendi-Lopez A, Nottmeier E, Bydon M, McClendon J, Buchanan IA, Pirris S, Abode-Iyamah K, Chen S. Frailty as a Predictor of Postoperative Morbidity and Mortality in Patients Aged 80 Years and Older Undergoing Instrumented Fusion. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01019. [PMID: 38189376 DOI: 10.1227/ons.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Degenerative spine disease is a leading cause of disability, with increasing prevalence in the older patients. While age has been identified as an independent predictor of outcomes, its predictive value is limited for similar older patients. Here, we aimed to determine the most predictive frailty score of adverse events in patients aged 80 and older undergoing instrumented lumbar fusion. METHODS We proceeded with a multisite (3 tertiary academic centers) retrospective review including patients undergoing instrumented fusion aged 80 and older from January 2010 to present. A composite end point encompassing 30-day return to operating room, readmission, and mortality was created. We estimated the area under the receiver operating characteristic curve for frailty scores (Modified Frailty Index-5 [MFI-5], Modified Frailty Index-11 [MFI-11], and Charlson Comorbidity Index [CCI]) in relation to that composite score. In addition, we estimated the association between each score and the composite end point by means of logistic regression. RESULTS A total of 153 patients with an average age of 85 years at the time of surgery were included. We observed a 30-day readmission rate of 11.1%, reoperation of 3.9%, and mortality of 0.6%. The overall rate of the composite end point at 30 days was 25 (15.1%). The AUC for MFI-5 was 0.597 (0.501-0.693), for MFI-11 was 0.620 (0.518-0.723), and for CCI was 0.564 (0.453-0.675). The association between the scores and composite end point did not reach statistical significance for MFI-5 (odds ratio [OR] = 1.45 [0.98-2.15], P = .061) and CCI (OR = 1.13 [0.97-1.31], P = .113) but was statistically significant for MFI-11 (OR = 1.46 [1.07-2.00], P = .018). CONCLUSION This is the largest study comparing frailty index scores in octogenarians undergoing instrumented lumbar fusion. Our findings suggest that while MFI-11 score correlated with adverse events, the predictive ability of existing scores remains limited, highlighting the need for better approaches to identify select patients at age extremes.
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Affiliation(s)
- Diogo Moniz-Garcia
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Nour Odeh
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Oktay Genel
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
- School of Medicine, King's College London, London, UK
| | - Alaa Montaser
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Gaetano De Biase
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Eric Nottmeier
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamal McClendon
- Department of Neurologic Surgery, Mayo Clinic, Scottsdale, Arizona, USA
| | - Ian A Buchanan
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephen Pirris
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Selby Chen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Han G, Wang W, Yue L, Fan Z, Li Z, Li J, Sun Z, Li W. Age-Dependent Differences of Paraspinal Muscle Endurance and Morphology in Chinese Community Population Without Chronic Low Back Pain. Global Spine J 2024; 14:235-243. [PMID: 35584688 PMCID: PMC10676164 DOI: 10.1177/21925682221103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Our aim was to describe age-dependent changes of lumbar paraspinal muscle endurance and morphology in Chinese healthy population. We also explored the relationship between paraspinals endurance and morphology. METHODS A total of 181 participants from Chinese community population without chronic low back pain were included. The participants were divided into three groups: young (20-39 years old, n = 29), middle (40-59 years old, n = 93), and elderly (≥ 60 years old, n = 59). The Ito test was performed to evaluate the isometric endurance of paraspinal muscles. The total cross-sectional area (TCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES) were measured at L1-L5 levels on magnetic resonance imaging. Physical activity level was evaluated using the physical activity index and comorbidities were assessed by the modified 5-item frailty index. RESULTS The elderly group had a shorter performance time of endurance test than the young group and middle-aged group. Correlation analysis showed that age had a significant correlation with endurance test, the average MF TCSA, MF FI, ES TCSA and ES FI of L1-5. In addition, PAI had a significant correlation with endurance test and MF FI. In multiple linear regression analysis, paraspinals endurance was associated with MF FI, ES FI, physical activity level and comorbidities. CONCLUSION Age-related decreases in paraspinals endurance and TCSA, and an increase in FI were revealed. Besides, paraspinal muscles FI, but not TCSA, was negatively associated with the endurance of paraspinals.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Beijing, China
| | - Lihao Yue
- Peking University Health Science Center, Beijing, China
| | - Zheyu Fan
- Peking University Health Science Center, Beijing, China
| | - Zonglin Li
- Peking University Health Science Center, Beijing, China
| | - Jiaming Li
- Peking University Health Science Center, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
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Zhong J, Lee NJ, Padaki A, Crutchfield C, Ahmad CS, Trofa D, Sean Lynch T. Increased age and modified fragility index increases risk of short-term complications after anterior cruciate ligament reconstruction surgery. Knee 2024; 46:8-18. [PMID: 37972422 DOI: 10.1016/j.knee.2023.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Large data analysis of anterior cruciate ligament reconstruction (ACLR) short-term complications on age will help surgeons stratify and counsel at-risk patients. The purpose of this study is to assess if older patients are at greater risk for short-term complications after ACLR. METHODS This retrospective cohort study included patients who underwent elective ACLR with or without concomitant meniscal procedures in the National Surgical Quality Improvement Program from 2005 to 2017. Patients were divided into age groups 16-30, 31-45, and > 45. Modified fragility index-5 (mFI-5), demographics and short-term outcomes were examined with bivariate and multivariate analysis to determine if age was a risk factor for complications. RESULTS A total of 23,581 patients (35.4% female) were included in this analysis. Mean age was 32.1 ± 10.8 years. Older patients had higher mFI-5 scores (p < 0.001), shorter operative times (p < 0.001), lower use of only general anesthesia (p < 0.001). The oldest patients had similar rates of complications as the two younger groups. Older age was an independent risk factor for VTE, but decreased risk of prolonged operations. A mFI-5 > 0 increased risk factors for readmission (Odds ratio 2.2, P = 0.006). Infection was the most common cause 30-day readmissions (40/135, 29.6%). CONCLUSION In the early postoperative period, older age is an independent risk factor for VTE and younger age is a significant factor for prolonged surgeries. Having an mFI-5 > 0 increased risk factors for readmission.
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Affiliation(s)
- Jack Zhong
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States; New York University Langone Health Dept. of Orthopaedic Surgery, 301 E 17th St, New York, NY 10010, United States.
| | - Nathan J Lee
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Ajay Padaki
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Connor Crutchfield
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Christopher S Ahmad
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - David Trofa
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - T Sean Lynch
- Columbia Univ. Dept. of Orthopaedic Surgery, 161 Fort Washington Avenue, New York, NY 10032, United States; Henry Ford Health Dept. of Orthopaedic Surgery, 40777 Ann Arbor Rd, Plymouth, MI 48170, United States
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Casciato DJ, Kirkham K, Wynes J. 30-Day Readmission Following Outpatient Transmetatarsal Amputation in the Geriatric Population: An ACS NSQIP Analysis. J Foot Ankle Surg 2024; 63:55-58. [PMID: 37661019 DOI: 10.1053/j.jfas.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/01/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023]
Abstract
Whether secondary to deformity, traumatic injury, infection, neoplasm, or ischemic disease, the transmetatarsal amputation provides a functional means of limb preservation prior to major proximal amputation. With similar readmission rates following inpatient and outpatient surgery, prevention of an unnecessary admission among vulnerable patients, specifically geriatrics, proves beneficial. This investigation examines differences among geriatric patients admitted and not requiring readmission following outpatient transmetatarsal amputation. An ACS NSQIP database analysis following filtering for CPT 28805, specific for transmetatarsal amputations, was performed among geriatric patients. Patient demographic, medical history, operative characteristics, and social/functional determinants were compared between the no admission and readmission cohorts. The threshold for statistical significance was set at p ≤ .05. Overall, a 19% readmission rate was reported among geriatric patients who underwent an outpatient transmetatarsal amputation. No statistically significant difference among patient demographics, past medical history, or surgical presentation was found between cohorts. Geriatric patients that maintained some level of functional dependence were 3.41 times more likely to be readmitted than the nonreadmission cohort (p = .006). Among geriatric patients undergoing outpatient transmetatarsal amputation, function status should be taken into account prior to surgery. Greater consideration should also be given to patients who do not maintain independence during their activities of daily living. As the population continues to age, recognizing social circumstances associated with the geriatric population proves important in preventing readmission.
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Affiliation(s)
- Dominick J Casciato
- Fellow, Limb Preservation and Deformity Correction Fellowship, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
| | | | - Jacob Wynes
- Fellowship Director, Limb Preservation and Deformity Correction Fellowship, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
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Deldar R, Huffman SS, Bovill JD, Gupta N, Truong BN, Haffner ZK, Sayyed AA, Fan KL, Evans KK. Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction. Microsurgery 2024; 44:e31135. [PMID: 38124444 DOI: 10.1002/micr.31135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/30/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Identifying at-risk patients for complications remains challenging in patients with chronic lower extremity (LE) wounds receiving free tissue transfer (FTT) for limb salvage. The modified-5 frailty index (mFI-5) has been utilized to predict postoperative complications, yet it has not been studied in this population. The aim of this study was to determine the utility of the mFI-5 in predicting adverse postoperative outcomes. METHODS Patients ≥60 years, who underwent LE FTT reconstruction at a single institution from 2011 to 2022, were retrospectively reviewed. Patient characteristics, mFI-5, and postoperative outcomes were collected. Cohorts were divided by an mFI-5 score of <2 or ≥2. RESULTS A total of 115 patients were identified, of which 71.3% (n = 82) were male, 64.3% (n = 74) had a mFI-5 score of ≥2, and 35.7% (n = 41) had a score <2. The average age and body mass index were 67.8 years and 28.7 kg/m2 , respectively. The higher mFI-5 cohort had lower baseline albumin levels (3.0 vs. 4.0 g/dL, p = .015) and higher hemoglobin A1c levels (7.4 vs. 5.8%, p < .001). The postoperative length of stay was longer in the higher mFI-5 cohort (18 vs. 13.4 days, p = .003). The overall flap success was 96.5% (n = 111), with no difference between cohorts (p = .129). Postoperative complications were comparable between cohorts (p = .294). At a mean follow-up of 19.8 months, eight patients (7.0%) underwent amputation, and 91.3% (n = 105) were ambulatory. CONCLUSION High microsurgical success rates can be achieved in comorbid patients with high frailty indexes who undergo FTT for limb salvage. A multidisciplinary team approach may effectively mitigate negative outcomes in elderly, frail patients.
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Affiliation(s)
- Romina Deldar
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - John D Bovill
- Georgetown University School of Medicine, Washington, DC, USA
| | - Nisha Gupta
- Georgetown University School of Medicine, Washington, DC, USA
| | - Brian N Truong
- Georgetown University School of Medicine, Washington, DC, USA
| | - Zoë K Haffner
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Adaah A Sayyed
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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Moura SP, Shaffrey EC, Lam CS, Seitz AJ, Edalatpour A, Israel JS, Michelotti BF, Grimes MD, Williams DH, Poore SO. Modified Frailty Index predicts postoperative complications following adult-acquired buried penis surgery: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2024; 88:493-499. [PMID: 38101263 DOI: 10.1016/j.bjps.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Given that patients with morbid obesity are predisposed to frailty, we sought to determine whether the 5-Factor Modified Frailty Index (mFI-5) predicts postoperative complications following surgery for adult-acquired buried penis, and secondarily, to compare the mFI-5 to body mass index (BMI) and American Society of Anesthesiologists (ASA) status as preoperative risk stratification measures. METHODS We included all patients who underwent surgical management for adult-acquired buried penis at an academic Level I trauma center between 2015 and 2023. A manual chart review was performed to collect data on patient demographics, modified frailty index variables, intraoperative data, postoperative outcomes, and complications. RESULTS A total of 55 patients underwent surgical repair of adult-acquired buried penis, with 26 experiencing postoperative complications (47.3%). Univariable regression analyses revealed that the mFI-5 was a significant predictor of postoperative complications (odds ratio [OR] 3.40, 95% confidence interval [CI]: 1.56-7.42, p = .002), ongoing postoperative urinary problems (OR 2.03, 95% CI: 1.02-4.05, p = .045), patient dissatisfaction with outcomes (OR 3.29, 95% CI: 1.35-8.02, p = .009), and persistent postoperative symptoms (OR 2.42, 95% CI: 1.10-5.35, p = .029). There was no significant association between ASA classification and postoperative complications (OR 1.59, 95% CI:.544-4.63, p = .398). Multivariable analysis demonstrated that the mFI-5 was an independent predictor of postoperative complications (OR 5.34, 95% CI: 1.80-15.9, p = .003) when controlling for BMI and age. CONCLUSION The mFI-5 is an independent predictor of postoperative complications in patients undergoing surgical repair of adult-acquired buried penis. The simplicity of the index permits efficient preoperative risk stratification of adult-acquired buried penis patients and provides important counseling information that may not be reflected by age or BMI alone.
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Affiliation(s)
- Steven P Moura
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ellen C Shaffrey
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chloe S Lam
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Allison J Seitz
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Armin Edalatpour
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jacqueline S Israel
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Brett F Michelotti
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew D Grimes
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel H Williams
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Samuel O Poore
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Hassan AM, Paidisetty P, Ray N, Govande JG, Nelson JA, Mehrara BJ, Butler CE, Mericli AF, Selber JC. Frail but Resilient: Frailty in Autologous Breast Reconstruction is Associated with Worse Surgical Outcomes but Equivalent Long-Term Patient-Reported Outcomes. Ann Surg Oncol 2024; 31:659-671. [PMID: 37864119 DOI: 10.1245/s10434-023-14412-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/19/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Frailty is associated with higher risk of complications following breast reconstruction, but its impact on long-term surgical and patient-reported outcomes has not been investigated. We examined the association of the five-item modified frailty index (MFI) score with long-term surgical and patient-reported outcomes in autologous breast reconstruction. PATIENTS AND METHODS We conducted a retrospective cohort study of consecutive patients who underwent mastectomy and autologous breast reconstruction between January 2016 and April 2022. Primary outcome was any flap-related complication. Secondary outcomes were patient-reported outcomes and predictors of complications in the frail cohort. RESULTS We identified 1640 reconstructions (mean follow-up 24.2 ± 19.2 months). In patients with MFI ≥ 2, the odds of surgical [odds ratio (OR) 2.13, p = 0.023] and medical (OR 17.02, p < 0.001) complications were higher than in nonfrail patients. We found no significant difference in satisfaction with the breast (p = 0.287), psychosocial well-being (p = 0.119), or sexual well-being (p = 0.314) according to MFI score. Chronic obstructive pulmonary disease was an independent predictor of infection (OR 3.70, p = 0.002). Tobacco use (OR 7.13, p = 0.002) and contralateral prophylactic mastectomy (OR 2.36, p = 0.014) were independent predictors of wound dehiscence. Dependent functional status (OR 2.36, p = 0.007) and immediate reconstruction (compared with delayed reconstruction; OR 3.16, p = 0.026) were independent predictors of skin flap necrosis. Dependent functional status was also independently associated with higher odds of reoperation (OR 2.64, p = 0.011). CONCLUSION Frailty is associated with higher risk of complications in breast reconstruction, but there is no significant difference in long-term patient-reported outcomes. MFI should be considered in breast reconstruction to improve outcomes in high-risk frail patients.
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Affiliation(s)
- Abbas M Hassan
- Division of Plastic and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Praneet Paidisetty
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nicholas Ray
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Janhavi G Govande
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jonas A Nelson
- Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles E Butler
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander F Mericli
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Han G, Zhou S, Qiu W, Fan Z, Yue L, Li W, Wang W, Sun Z, Li W. Role of the Paraspinal Muscles in the Sagittal Imbalance Cascade: The Effects of Their Endurance and of Their Morphology on Sagittal Spinopelvic Alignment. J Bone Joint Surg Am 2023; 105:1954-1961. [PMID: 37856573 DOI: 10.2106/jbjs.22.01175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND The role of paraspinal muscle degeneration in the cascade of sagittal imbalance is still unclear. This study aimed to compare paraspinal muscle degeneration in the 4 stages of sagittal imbalance: sagittal balance (SB), compensated sagittal balance (CSB), decompensated sagittal imbalance (DSI), and sagittal imbalance with failure of pelvic compensation (SI-FPC). In addition, it aimed to compare the effects paraspinal muscle endurance and morphology on sagittal spinopelvic alignment in patients with lumbar spinal stenosis. METHODS A cross-sectional study of 219 patients hospitalized with lumbar spinal stenosis was performed. The isometric paraspinal extensor endurance test and evaluation of atrophy and fat infiltration of the paraspinal extensor muscles and psoas major on magnetic resonance imaging were performed at baseline. Spinopelvic parameters including lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and the sagittal vertical axis were measured. RESULTS The patients with lumbar spinal stenosis were divided into 67 with SB, 85 with CSB, 49 with DSI, and 17 with SI-FPC. There were significant differences in paraspinal muscle endurance and morphology among the 4 groups. Furthermore, the SI-FPC group had poorer paraspinal muscle endurance than either the SB or the CSB group. In multiple linear regression analysis, paraspinal muscle endurance and the relative functional cross-sectional area of the paraspinal extensor muscles were the independent predictors of the sagittal vertical axis, and the relative functional cross-sectional area of the psoas major was the independent predictor of relative pelvic version. CONCLUSIONS This study indicated that paraspinal muscle degeneration is not only an initiating factor in pelvic retroversion but also a risk factor for progression from a compensated to a decompensated stage. Specifically, the impairment of muscle endurance in the CSB stage may be the reason why patients experience failure of pelvic compensation. In addition, paraspinal muscle endurance and muscle morphology (relative functional cross-sectional area of the paraspinal extensor muscles and psoas major) had different clinical consequences. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gengyu Han
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Siyu Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Weipeng Qiu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Zheyu Fan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Lihao Yue
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Wei Wang
- Department of Orthopaedics, Tianjin Hospital, Tianjin, People's Republic of China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, People's Republic of China
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Filippidis AS, Phillips KR, Lopez-Rivera V, Enriquez-Marulanda A, Mackel CE, Alterman RL, Vega RA. Surgery in octogenarians with intracranial meningiomas improves functional outcome at 1 year. Acta Neurochir (Wien) 2023; 165:4183-4189. [PMID: 37831227 DOI: 10.1007/s00701-023-05827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE The population is aging, and age remains an important factor in deciding surgical candidacy for intracranial tumors. The natural history and surgical behavior of meningiomas in octogenarians are not well understood. We evaluated the surgical and functional outcomes, including survival, among octogenarians with intracranial meningiomas in a single institution. METHODS The Tumor Registry (2004-2021) was used to identify octogenarian patients (ages 80-89) diagnosed with intracranial meningioma. Primary endpoints were 1-year survival and functional outcome measured with mRS postsurgery. Kaplan-Meier, univariable Log-rank tests, and multivariable Cox hazards proportional regression models were used for assessing factors associated with overall survival (OS) in octogenarians with meningiomas who underwent surgery; logistic regression and McNemar's were used to further characterize risk factors affecting functional surgical outcome at 1 year. RESULTS Thirty octogenarians with intracranial meningioma who underwent surgery were identified. Median age was 82.5 years and 66.6% were female patients. The 1-year median postsurgical survival probability for all octogenarians with meningioma was 86.3% and no intraoperative mortality was observed. Frailty (mFI-5, p = 0.84), tumor grade (p = 0.11), tumor size (p = 0.22), extent of resection (p = 0.35), and Karnofsky scale on admission (p = 0.93) did not significantly affect the survival in octogenarians with meningiomas which were treated surgically. The 1-year postoperative functional status of octogenarian meningioma patients who underwent surgery was significantly improved compared to pre-op mRS (McNemar's chi-squared = 9.6, df = 1, p-value = 0.001946). CONCLUSION In octogenarians with meningiomas, surgical intervention significantly improves the pre-operative modified Rankin Scale at 1 year postsurgery in this cohort.
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Affiliation(s)
- Aristotelis S Filippidis
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katharine R Phillips
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Charles E Mackel
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ron L Alterman
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rafael A Vega
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Baek W, Park SY, Kim Y. Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis. BMC Geriatr 2023; 23:771. [PMID: 37996826 PMCID: PMC10668507 DOI: 10.1186/s12877-023-04448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Degenerative spinal diseases are common in older adults with concurrent frailty. Preoperative frailty is a strong predictor of adverse clinical outcomes after surgery. This study aimed to investigate the association between health-related outcomes and frailty in patients undergoing spine surgery for degenerative spine diseases. METHODS A systematic review and meta-analysis were performed by electronically searching Ovid-MEDLINE, Ovid-Embase, Cochrane Library, and CINAHL for eligible studies until July 16, 2022. We reviewed all studies, excluding spinal tumours, non-surgical procedures, and experimental studies that examined the association between preoperative frailty and related outcomes after spine surgery. A total of 1,075 articles were identified in the initial search and were reviewed by two reviewers, independently. Data were subjected to qualitative and quantitative syntheses by meta-analytic methods. RESULTS Thirty-eight articles on 474,651 patients who underwent degenerative spine surgeries were included and 17 papers were quantitatively synthesized. The health-related outcomes were divided into clinical outcomes and patient-reported outcomes; clinical outcomes were further divided into postoperative complications and supportive management procedures. Compared to the non-frail group, the frail group was significantly associated with a greater risk of high mortality, major complications, acute renal failure, myocardial infarction, non-home discharge, reintubation, and longer length of hospital stay. Regarding patient-reported outcomes, changes in scores between the preoperative and postoperative Oswestry Disability Index scores were not associated with preoperative frailty. CONCLUSIONS In degenerative spinal diseases, frailty is a strong predictor of adverse clinical outcomes after spine surgery. The relationship between preoperative frailty and patient-reported outcomes is still inconclusive. Further research is needed to consolidate the evidence from patient-reported outcomes.
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Affiliation(s)
- Wonhee Baek
- College of Nursing, Gyeongsang National University, Jinju-si, Gyeongsangnam-do, South Korea
| | - Sun-Young Park
- College of Nursing, Daegu Catholic University, Daegu-si, South Korea
| | - Yoonjoo Kim
- Department of Nursing, College of Healthcare Sciences, Far East University, Eumseong-gun, Chungcheongbuk-do, South Korea.
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Mouchtouris N, Luck T, Locke K, Hines K, Franco D, Yudkoff C, Sivaganesan A, Heller J, Prasad S, Harrop J, Jack Jallo. Comparison of 5-Item and 11-Item Modified Frailty Index as Predictors of Functional Independence in Patients With Spinal Cord Injury. Global Spine J 2023:21925682231211279. [PMID: 37918861 DOI: 10.1177/21925682231211279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. INTRODUCTION The 11-item modified Frailty index (mFI-11) by the ACS-NSQIP database was used to predict which patients are high risk for complications and inpatient mortality. ACS-NSQIP now has switched to the 5-item MFI. However, there are no studies on how these frailty indices fare against each other and their prognostic value of functional independence in patients with spinal cord injury (SCI). OBJECTIVE To compare the mFI-5 and mFI-11 in order to standardize frailty assessment in the SCI population. METHODS Retrospective analysis of 272,174 patients with SCI from 2010 to 2020 from the Pennsylvania Trauma Systems Foundation (PTSF) registry. Multivariable logistic regression was used to determine the predictive value of mFI for functional independence as determined by locomotion and transfer mobility. RESULTS A total of 1907 patients were included with a mean age of 46.9 ± 15.1 years. The 3 most common MFI factors were hypertension (32.2%), diabetes mellitus (13.7%) and chronic obstructive pulmonary disease (8.5%). Multivariable logistic regression analyses using MFI-5 and MFI-11 showed that a higher frailty score in MFI-5 (OR 1.375, P < .001) and in MFI-11 (OR 1.366, P < .001) were each predictive of poor functional status at discharge. ROC curves for the MFI-5 (AUC = .818, P < .001) and MFI-11 (AUC = .819, P < .001) demonstrated excellent diagnostic accuracy. CONCLUSION The new MFI-5 is equivalent to its predecessor, the MFI-11, and predictive of functional outcomes in patients with SCI. MFI-5 can serve as the preferred frailty index at the point of care and in research contexts.
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Affiliation(s)
- Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Trevor Luck
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Katherine Locke
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Kevin Hines
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Daniel Franco
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Clifford Yudkoff
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Joshua Heller
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Srinivas Prasad
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson Universityand Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
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Demirci A, Hamidi N, Uzel T, Başar H. The 5-Factor Modified Frailty Index is effective in treatment decision and the determination of perioperative complications in patients with localized prostate cancer. Support Care Cancer 2023; 31:603. [PMID: 37779118 DOI: 10.1007/s00520-023-08078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To determine the active treatment option and perioperative complications using the 5-Factor Modified Frailty Index (mFI-5) in localized prostate cancer patients. MATERIAL AND METHODS Patients diagnosed with localized prostate cancer in our clinic between January 2018 and October 2022 were evaluated. The patients were separated according to the mFI-5 scores as Group 1 (score = 0, n = 74), Group 2 (score = 1, n = 41), and Group 3 (score ≥ 2, n = 69). Factors affecting the determination of treatment selection, oncological results, and surgical complications were identified with regression analysis. RESULTS The mean age of the patients in Group 1 was lower than in Group 2 and Group 3 (63.09 ± 7.25 years vs. 67.56 ± 7.98 years and 69.2 ± 6.77 years, p < 0.001, respectively). In Group 1, more patients were treated with retropubic radical prostatectomy (RRP), and in Group 3 with radiotherapy (RT) and active surveillance (AS) (62.2%, 53.6%, and 17.4%, p = 0.001, respectively). The rate of Clavien-Dindo grade 3 and 4 complication rates were higher in Group 3 than in Group 1 (50% vs. 8.7%, p < 0.001, respectively). Frailty was found to be an independent risk factor for overall survival (HR: 10.68, p = 0.02), the presence of Clavien-Dindo ≥ 3 complication (HR: 4.9, p = 0.02) and determination of RT/AS as the active treatment option (HR: 2.45, p = 0.04). CONCLUSION In patients with frailty according to the mFI-5, the complication rate after RRP in localized prostate cancer increased. When selecting the treatment to be applied in these patients, it will be useful to also evaluate the frailty status.
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Affiliation(s)
- Aykut Demirci
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey.
| | - Nurullah Hamidi
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey
| | - Tuncel Uzel
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey
| | - Halil Başar
- Department of Urology, University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Mehmet Akif Ersoy Mah. Vatan Cad. No: 91, 06200, Ankara, Turkey
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Wafi A, Kolli V, Azhar B, Poole G, Budge J, Moxey P, Loftus I, Holt P. Amputation of the Unsalvageable Leg in Vascular Patients with Cancer. Vasc Endovascular Surg 2023; 57:697-705. [PMID: 37070430 DOI: 10.1177/15385744231171752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVES The aim of this study was to compare outcomes of major lower limb amputation (MLA) in patients with and without cancer and with cancer patients receiving palliation over amputation for their unsalvageable limb. METHODS Cancer patients who underwent a major amputation or palliation between 2013 and 2018 were included. Comparison groups were cancer-MLA (active/managed cancers), non-cancer MLA (historic cancer or no cancer history) and cancer-palliation at presentation with unsalvageable limbs. Prospectively collected data was retrospectively analysed for outcomes including survival, postoperative complications, length of stay, suitability for rehabilitation and discharge destination. RESULTS 262 (cancer and non-cancer) patients underwent MLA and 18 patients with cancer received palliation. Of those amputated, 26 (9.9%) had active or managed cancer, of which 12 were diagnosed in the 6 months before MLA. Cancer-MLA patients presented with more acute ischaemia compared to non-cancer patients. Median survival was significantly different between the cancer-MLA (14.1 [9.5 - 29.5, 95% CI] months), non-cancer MLA (57.7 [45 - 73.6, 95% CI] months) and cancer-palliation (.6 [.4 - 2.3, 95% CI] months) groups, P < .001. A significantly higher proportion of cancer-MLA patients (10/26, 38.5%) were deemed unsuitable for rehabilitation in post-operative assessment compared to non-cancer MLA (21/236, 8.9%) patients, P < .001. There was a variation in destinations of discharge, with a greater proportion of cancer-MLA patients (4/26, 15.4%) going to a nursing home compared to non-cancer MLA (10/236, 4.2%) patients, P = .016. CONCLUSION Cancer is prevalent among vascular amputees, with a large proportion being occult diagnoses. Cancer is associated with poorer outcomes following amputation, but survival remains significantly better compared to palliation in cancer patients presenting with unsalvageable limbs.
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Affiliation(s)
- Arsalan Wafi
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Vijay Kolli
- Douglas Bader Rehabilitation Unit, Queen Mary's Hospital, London, UK
| | - Bilal Azhar
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Grace Poole
- St George's Medical School, University of London, London, UK
| | - James Budge
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Paul Moxey
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Ian Loftus
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Peter Holt
- St George's Vascular Institute, St George's University Hospital, London, UK
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Castel X, Pelletier JB, Sulpis B, Charier D, Buhot B, Mihail G, Carlioz V, Barral-Clavel F, Sylvain G, Tetard MC, Vassal F. MFI-11 Predicts Post-Operative Serious Complications in Patients Undergoing Surgery for Odontoid Fractures. Global Spine J 2023:21925682231205103. [PMID: 37776203 DOI: 10.1177/21925682231205103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVES The objective of this study was to analyze postoperative complications in different mFI-11 groups after surgery for odontoid fractures in a geriatric population. METHODS A single center retrospective review of odontoid fractures surgery (between 2013 and 2022) in patients aged 65 years and older was conducted. The primary outcome was the occurrence of a major complication (Calvien-Dindo ≥4) within 30 days post-surgery. The secondary outcome was the occurrence of a major complication within 3 months after surgery, and death within 1-month post-surgery. Survival curve, multi-variate analysis was performed and adjusted receiver operating characteristic curves were generated. RESULTS There were 92 patients included in this study, with a mean age of 80.5 years. Serious complication occurred for 16 patients (17%) during hospitalization. Multivariate analysis demonstrated an mFI 11 >.27 was strongly and independently associated with serious complications within 1-month post-surgery (OR = 16.7, 95% CI = 4.50-83), as well as serious complications within 3 months post-surgery (OR = 11.8, 95% CI = 3.48-49.1) and death within 1 month post-surgery (OR = 11.7; 95% CI = 3.02-60.4). The Receiver Operator Characteristics (ROC) curves for the three models all have an Area Under the Curve (AUC) value greater than 0.7. CONCLUSIONS The mFI-11 is a straightforward and validated tool that can be used during the preoperative period to identify the patient's level of frailty and assess their risk of postoperative complications. Patients with mFI-11 ≥.27 are at greater risk of serious complications within 1 and 3 months' post-surgery and death within 1 month post-surgery.
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Affiliation(s)
- Xavier Castel
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Jean-Baptiste Pelletier
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Benoit Sulpis
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - David Charier
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Benjamin Buhot
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Gurschi Mihail
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Violette Carlioz
- Dermatology Department, Centre Hospitalier de Firminy, Firminy, France
| | - Fanelie Barral-Clavel
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Granges Sylvain
- Radiology Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Marie-Charlotte Tetard
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Francois Vassal
- Neurosurgery Department, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
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Clements NA, Gaskins JT, Martin RCG. Predictive Ability of Comorbidity Indices for Surgical Morbidity and Mortality: a Systematic Review and Meta-analysis. J Gastrointest Surg 2023; 27:1971-1987. [PMID: 37430092 DOI: 10.1007/s11605-023-05743-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Several contemporary risk stratification tools are now being used since the development of the Charlson Comorbidity Index (CCI) in 1987. The purpose of this systematic review and meta-analysis was to compare the utility of commonly used co-morbidity indices in predicting surgical outcomes. METHODS A comprehensive review was performed to identify studies reporting an association between a pre-operative co-morbidity measurement and an outcome (30-day/in-hospital morbidity/mortality, 90-day morbidity/mortality, and severe complications). Meta-analysis was performed on the pooled data. RESULTS A total of 111 included studies were included with a total cohort size 25,011,834 patients. The studies reporting the 5-item Modified Frailty Index (mFI-5) demonstrated a statistical association with an increase in the odds of in-hospital/30-day mortality (OR:1.97,95%CI: 1.55-2.49, p < 0.01). The pooled CCI results demonstrated an increase in the odds for in-hospital/30-day mortality (OR:1.44,95%CI: 1.27-1.64, p < 0.01). Pooled results for co-morbidity indices utilizing a scale-based continuous predictor were significantly associated with an increase in the odds of in-hospital/30-day morbidity (OR:1.32, 95% CI: 1.20-1.46, p < 0.01). On pooled analysis, the categorical results showed a higher odd for in-hospital/30-day morbidity (OR:1.74,95% CI: 1.50-2.02, p < 0.01). The mFI-5 was significantly associated with severe complications (Clavien-Dindo ≥ III) (OR:3.31,95% CI:1.13-9.67, p < 0.04). Pooled results for CCI showed a positive trend toward severe complications but were not significant. CONCLUSION The contemporary frailty-based index, mFI-5, outperformed the CCI in predicting short-term mortality and severe complications post-surgically. Risk stratification instruments that include a measure of frailty may be more predictive of surgical outcomes compared to traditional indices like the CCI.
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Affiliation(s)
- Noah A Clements
- The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Jeremy T Gaskins
- The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Robert C G Martin
- The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA.
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Zhang D, Ostergaard PJ, Hall MJ, Shoji M, Earp BE. The Relationship Between Frailty and Functional Outcomes, Range of Motion, and Reoperation After Reverse Total Shoulder Arthroplasty for Proximal Humerus Fracture. Orthopedics 2023; 46:274-279. [PMID: 37018624 DOI: 10.3928/01477447-20230330-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The objective of this study was to investigate whether frailty is associated with functional outcomes, motion, and reoperation at a minimum of 2 years after reverse total shoulder arthroplasty (rTSA) for proximal humerus fracture. We performed a retrospective study of 153 patients who underwent rTSA for proximal humerus fracture at two level 1 trauma centers from 2003 to 2018 with minimum 2-year follow-up. Frailty was assessed using the modified 5-item frailty index (mFI). The primary outcome variable was the American Shoulder and Elbow Surgeons (ASES) shoulder score at minimum 2-year follow-up. The secondary outcome variables were the Shoulder Pain and Disability Index (SPADI), the Shoulder Subjective Value (SSV), the 0 to 10 numeric rating scale (NRS) pain score, surgical complication, and reoperation. Bivariate comparisons were made between mFI and outcome variables. The mean age of the 153 patients was 70 years, and 76% were women. Forty patients (26%) had a mFI score of 0, 65 patients (42%) had a mFI score of 1, 40 patients (26%) had a mFI score of 2, and 8 patients (5%) had a mFI score of 3. Twenty-seven patients (18%) had complications, and 21 patients (14%) underwent reoperation. At minimum 2-year follow-up, mFI was not associated with ASES shoulder score, SPADI, SPADI pain or disability subscales, SSV, NRS pain score, active and passive shoulder forward flexion, abduction, and external rotation, complication, or reoperation. Provided they survive the initial physiologic insults of trauma and surgery, patients with higher mFI scores treated with rTSA for proximal humerus fracture can expect similar medium-term restoration of shoulder function. [Orthopedics. 2023;46(5):274-279.].
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Seitz ML, Katz A, Strigenz A, Song J, Verma RB, Virk S, Silber J, Essig D. Modified frailty index independently predicts morbidity in patients undergoing 3-column osteotomy. Spine Deform 2023; 11:1177-1187. [PMID: 37074517 DOI: 10.1007/s43390-023-00685-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Adult Spinal Deformity (ASD) includes a spectrum of spinal conditions that can be associated with significant pain and loss of function. While 3-column osteotomies have been the procedures of choice for ASD patients, there is also a substantial risk for complications. The prognostic value of the modified 5-item frailty index (mFI-5) for these procedures has not yet been studied. The goal of this study is to evaluate the association of mFI-5 with 30-day morbidity, readmission, and reoperation following a 3-column osteotomy. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried to identify patients undergoing 3-Column Osteotomy procedures from 2011-2019. Multivariate modeling was utilized to assess mFI-5 and other demographic, comorbidity, laboratory, and perioperative variables as independent predictors of morbidity, readmission, and reoperation. RESULTS N = 971. Multivariate analysis revealed that mFI-5 = 1 (OR = 1.62, p = 0.015) and mFI-5 ≥ 2 (OR = 2.17, p = 0.004) were significant independent predictors of morbidity. mFI-5 ≥ 2 was a significant independent predictor of readmission (OR = 2.16, p = 0.022) while mFI-5 = 1 was not a significant predictor of readmission (p = 0.053). Frailty did not predict reoperation. CONCLUSION Frailty as defined by mFI-5 strongly and independently predicted increased odds of postoperative morbidity for patients undergoing 3-column osteotomy as surgical intervention for ASD. Only mFI-5 ≥ 2 was a significant independent predictor of readmission, while frailty did not predict reoperation. Other variables independently predicted increased and decreased odds of postoperative morbidity, readmission, and reoperation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mitchell Lee Seitz
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.
| | - Austen Katz
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Adam Strigenz
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Junho Song
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Rohit B Verma
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Sohrab Virk
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - Jeff Silber
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
| | - David Essig
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra University, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
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Tarawneh OH, Vellek J, Kazim SF, Thommen R, Roster K, Conlon M, Alvarez-Crespo DJ, Cole KL, Varela S, Dominguez JF, Mckee RG, Schmidt MH, Bowers CA. The 5-item modified frailty index predicts spinal osteotomy outcomes better than age in adult spinal deformity patients: an ACS - NSQIP analysis. Spine Deform 2023; 11:1189-1197. [PMID: 37291408 DOI: 10.1007/s43390-023-00712-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the utility of 5-Item Modified Frailty Index (mFI-5) as compared to chronological age in predicting outcomes of spinal osteotomy in Adult Spinal Deformity (ASD) patients. METHODS Using Current Procedural and Terminology (CPT) codes, the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) database was queried for adult patients undergoing spinal osteotomy from 2015 to 2019. Multivariate regression analysis was performed to evaluate the effect of baseline frailty status, measured by mFI-5 score, and chronological age on postoperative outcomes. Receiver-operating characteristic (ROC) curve analysis was performed to analyze the discriminative performance of age versus mFI-5. RESULTS A total of 1,789 spinal osteotomy patients (median age 62 years) were included in the analysis. Among the patients assessed, 38.5% (n = 689) were pre-frail, 14.6% frail (n = 262), and 2.2% (n = 39) severely frail using the mFI-5. Based on the multivariate analysis, increasing frailty tier was associated with worsening outcomes, and higher odds ratios (OR) for poor outcomes were found for increasing frailty tiers as compared to age. Severe frailty was associated with the worst outcomes, e.g., unplanned readmission (OR 9.618, [95% CI 4.054-22.818], p < 0.001) and major complications (OR 5.172, [95% CI 2.271-11.783], p < 0.001). In the ROC curve analysis, mFI-5 score (AUC 0.838) demonstrated superior discriminative performance than age (AUC 0.601) for mortality. CONCLUSIONS The mFI5 frailty score was found to be a better predictor than age of worse postoperative outcomes in ASD patients. Incorporating frailty in preoperative risk stratification is recommended in ASD surgery.
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Affiliation(s)
- Omar H Tarawneh
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Katie Roster
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | | | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Samantha Varela
- School of Medicine, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Rohini G Mckee
- Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA.
- Department of Neurosurgery MSC10 5615, Albuquerque, NM, 81731, USA.
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Patel N, Coban D, Changoor S, Sinha K, Hwang KS, Emami A. The 5-Factor Modified Frailty Index is Associated With Increased Risk of Reoperations and Adjacent Level Disease Following Single-Level Transforaminal Lumbar Interbody Fusion. Global Spine J 2023:21925682231196828. [PMID: 37596811 DOI: 10.1177/21925682231196828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To determine the predictive capability between the 5-factor modified frailty index (mFI-5) scores and adverse clinical and radiographic outcomes following single-level transforaminal lumbar interbody fusion (TLIF). METHODS All patients over the age of 50 undergoing single-level open or minimally invasive TLIF from 2012 to 2021 with a minimum follow-up of 1 year were identified. Deformity, trauma, emergency, and tumor cases were excluded as were patients undergoing revision surgeries. An mFI-5 score was computed for each patient using a set of five factors which included hypertension requiring medication, chronic obstructive pulmonary disease, diabetes mellitus, congestive heart failure, and partially or fully dependent functional status. Univariate and multivariate logistic regression analysis were performed to evaluate the impact of mFI-5 scores on readmissions, reoperations, and postoperative complications. RESULTS 156 patients were included and grouped according to their level of frailty: no-frailty (mFI = 0, n = 67), mild frailty (mFI = 1, n = 59), and severe frailty (mFI = 2+, n = 30). Multivariate analysis found high levels of frailty (mFI = 2+) to be independent predictors of reoperation (OR: 16.9, CI: 2.7 - 106.9, P = .003) and related readmissions (OR = 16.5, CI: 2.6 - 102.7, P = .003) as compared to the no-frailty group. An mFI-5 score of 2+ was also predictive of any complication (OR = 4.5, CI: 1.4 - 14.3, P = .01) and adjacent segment disease (ASD) (OR = 12.5, CI: 1.2 - 134.0, P = .037). CONCLUSION High levels of frailty were predictive of related readmissions, reoperations, any complications, and ASD in older adult patients undergoing single-level TLIF.
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Affiliation(s)
- Neil Patel
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Daniel Coban
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Stuart Changoor
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Ki Soo Hwang
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Arash Emami
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA
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