External validation of the adult spinal deformity (ASD) frailty index (ASD-FI)

  • Emily K. Miller
  • Alba Vila-Casademunt
  • Brian J. Neuman
  • Daniel M. Sciubba
  • Khaled M. Kebaish
  • Justin S. Smith
  • Ahmet Alanay
  • Emre R. Acaroglu
  • Frank Kleinstück
  • Ibrahim Obeid
  • Francisco Javier Sánchez Pérez-Grueso
  • Leah Y. Carreon
  • Frank J. Schwab
  • Shay Bess
  • Justin K. Scheer
  • Virginie Lafage
  • Christopher I. Shaffrey
  • Ferran Pellisé
  • Christopher P. Ames
  • The European Spine Study Group
  • The International Spine Study Group
Original Article
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Abstract

Purpose

To assess the ability of the recently developed adult spinal deformity frailty index (ASD-FI) to predict odds of perioperative complications, odds of reoperation, and length of hospital stay after adult spinal deformity (ASD) surgery using a database other than the one used to create the index.

Methods

We used the ASD-FI to calculate frailty scores for 266 ASD patients who had minimum postoperative follow-up of 2 years in the European Spine Study Group (ESSG) database. Patients were enrolled from 2012 through 2013. Using ASD-FI scores, we categorized patients as not frail (NF) (< 0.3 points), frail (0.3–0.5 points), or severely frail (SF) (> 0.5 points). Multivariable logistic regression, adjusted for preoperative and surgical factors such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and odds of major complications, odds of reoperation, and length of hospital stay.

Results

We categorized 135 patients (51%) as NF, 90 patients (34%) as frail, and 41 patients (15%) as SF. Overall mean ASD-FI score was 0.29 (range 0–0.8). The adjusted odds of experiencing a major intraoperative or postoperative complication (OR 4.5, 95% CI 2.0–10) or having a reoperation (OR 3.9, 95% CI 1.7–8.9) were higher for SF patients compared with NF patients. Mean hospital stay was 2.1 times longer (95% CI 1.8–2.4) for SF patients compared with NF patients.

Conclusions

Greater patient frailty, as measured by the ASD-FI, is associated with longer hospital stays and greater odds of major complications and reoperation.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Adult spinal deformity Comorbidities Complications Frailty index Functional status Preoperative risk stratification 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Ethical statement

Institutional review board approval for patient inclusion in this database was obtained by each of the sites that contributed patient information. Each patient signed a consent document before inclusion.

Supplementary material

586_2018_5575_MOESM1_ESM.pptx (139 kb)
Supplementary material 1 (PPTX 139 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Emily K. Miller
    • 1
  • Alba Vila-Casademunt
    • 2
  • Brian J. Neuman
    • 3
  • Daniel M. Sciubba
    • 4
  • Khaled M. Kebaish
    • 3
  • Justin S. Smith
    • 5
  • Ahmet Alanay
    • 6
  • Emre R. Acaroglu
    • 7
  • Frank Kleinstück
    • 8
  • Ibrahim Obeid
    • 9
  • Francisco Javier Sánchez Pérez-Grueso
    • 10
  • Leah Y. Carreon
    • 11
  • Frank J. Schwab
    • 12
  • Shay Bess
    • 13
  • Justin K. Scheer
    • 14
  • Virginie Lafage
    • 12
  • Christopher I. Shaffrey
    • 5
  • Ferran Pellisé
    • 2
  • Christopher P. Ames
    • 15
  • The European Spine Study Group
  • The International Spine Study Group
  1. 1.Department of Physical Medicine and RehabilitationStanford UniversityRedwood CityUSA
  2. 2.Spine Research UnitHospital Vall d’Hebron Institute of ResearchBarcelonaSpain
  3. 3.Department of Orthopaedic SurgeryThe Johns Hopkins UniversityBaltimoreUSA
  4. 4.Department of NeurosurgeryThe Johns Hopkins UniversityBaltimoreUSA
  5. 5.Department of NeurosurgeryUniversity of Virginia School of MedicineCharlottesvilleUSA
  6. 6.Spine Surgery UnitAcibadem Maslak HospitalIstanbulTurkey
  7. 7.Spine Surgery UnitAnkara Acibadem ARTES Spine CenterAnkaraTurkey
  8. 8.Department of Orthopedics and NeurosurgerySchulthess KlinikZurichSwitzerland
  9. 9.Department of Spine SurgeryBordeaux University HospitalBordeauxFrance
  10. 10.Spine Surgery UnitHospital Universitario La PazMadridSpain
  11. 11.Norton Leatherman Spine CenterUniversity of LouisvilleLouisvilleUSA
  12. 12.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  13. 13.Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for ChildrenDenverUSA
  14. 14.University of California San Diego School of MedicineSan DiegoUSA
  15. 15.Department of NeurosurgeryUniversity of California San Francisco School of MedicineSan FranciscoUSA

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