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Changes in frailty among patients hospitalized for spine pathologies during the COVID-19 pandemic in Germany—a nationwide observational study

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Abstract

Purpose

In spine care, frailty is associated with poor outcomes. The aim of this study was to describe changes in frailty in spine care during the coronavirus disease 2019 (COVID-19) pandemic and their relation to surgical management and outcomes.

Methods

Patients hospitalized for spine pathologies between January 1, 2019, and May 17, 2022, within a nationwide network of 76 hospitals in Germany were retrospectively included. Patient frailty, types of surgery, and in-hospital mortality rates were compared between pandemic and pre-pandemic periods.

Results

Of the 223,418 included patients with spine pathologies, 151,766 were admitted during the pandemic and 71,652 during corresponding pre-pandemic periods in 2019. During the pandemic, the proportion of high-frailty patients increased from a range of 5.1–6.1% to 6.5–8.8% (p < 0.01), while the proportion of low frailty patients decreased from a range of 70.5–71.4% to 65.5–70.1% (p < 0.01). In most phases of the pandemic, the Elixhauser comorbidity index (ECI) showed larger increases among high compared to low frailty patients (by 0.2–1.8 vs. 0.2–0.8 [p < 0.01]). Changes in rates of spine surgery were associated with frailty, most clearly in rates of spine fusion, showing consistent increases among low frailty patients (by 2.2–2.5%) versus decreases (by 0.3–0.8%) among high-frailty patients (p < 0.02). Changes in rates of in-hospital mortality were not associated with frailty.

Conclusions

During the COVID-19 pandemic, the proportion of high-frailty patients increased among those hospitalized for spine pathologies in Germany. Low frailty was associated with a rise in rates of spine surgery and high frailty with comparably larger increases in rates of comorbidities.

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Data availability

All data were stored and analyzed in pseudonymized form.

Code availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Cong T, Hall AJ, Jia Z, Christiano A, Elsevier HCK, Cheung ZB, Wellman D, Forsh D, Lane JM (2022) Conceptualizing biological aging and frailty in orthopaedics: a framework for clinical practice. J Bone Joint Surg Am 104:1212–1222. https://doi.org/10.2106/JBJS.21.01053

    Article  PubMed  Google Scholar 

  2. Lemos JL, Welch JM, Xiao M, Shapiro LM, Adeli E, Kamal RN (2021) Is frailty associated with adverse outcomes after orthopaedic surgery?: a systematic review and assessment of definitions. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.21.00065

    Article  PubMed  Google Scholar 

  3. Fried LP, Tangen CM, Walston J, A B Newman, C Hirsch, J Gottdiener, T Seeman, R Tracy, W J Kop, G Burke, M A McBurnie, Cardiovascular Health Study Collaborative Research Group (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146-156. https://doi.org/10.1093/gerona/56.3.m146

    Article  Google Scholar 

  4. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60:1487–1492. https://doi.org/10.1111/j.1532-5415.2012.04054.x

    Article  PubMed  Google Scholar 

  5. Syddall H, Roberts HC, Evandrou M, Cooper C, Bergman H, Aihie Sayer A (2010) Prevalence and correlates of frailty among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. Age Ageing 39:197–203. https://doi.org/10.1093/ageing/afp204

    Article  PubMed  Google Scholar 

  6. Chan V, Wilson JRF, Ravinsky R, Badhiwala JH, Jiang F, Anderson M, Yee A, Wilson JR, Fehlings MG (2021) Frailty adversely affects outcomes of patients undergoing spine surgery: a systematic review. Spine J 21:988–1000. https://doi.org/10.1016/j.spinee.2021.01.028

    Article  PubMed  Google Scholar 

  7. Veronesi F, Borsari V, Martini L, Visani A, Gasbarrini A, Brodano GB, Fini M (2021) The impact of frailty on spine surgery: systematic review on 10 years clinical studies. Aging Dis 12:625–645

    Article  PubMed  PubMed Central  Google Scholar 

  8. Laverdière C, Georgiopoulos M, Ames CP, Corban J, Ahangar P, Awadhi K, Weber MH (2022) Adult spinal deformity surgery and frailty: a systematic review. Global Spine J 12:689–699

    Article  PubMed  Google Scholar 

  9. Passias PG, Brown AE, Bortz C, Pierce K, Alas H, Ahmad W, Passfall L, Kummer N, Krol O, Lafage R, Lafage V, Burton D, Hart R, Anand N, Mundis G, Neuman B, Line B, Shaffrey C, Klineberg E, Smith J, Ames C, Schwab FJ, Bess S; International Spine Study Group (2021) A risk-benefit analysis of increasing surgical invasiveness relative to frailty status in adult spinal deformity surgery. Spine (Phila Pa 1976) 46:1087–1096. https://doi.org/10.1097/BRS.0000000000003977

  10. Gum JL, Yeramaneni S, Wang K, Hostin RA Jr, Kebaish KM, Neuman BJ, Jain A, Kelly MP, Burton DC, Ames CP, Shaffrey CI, Klineberg EO, Kim HJ, Protopsaltis TS, Passias PG, Mundis GM Jr, Eastlack RK, Schwab FJ, Hart RA, Gupta MC, Daniels AH, Smith JS, Lafage V, Line B, Bess S; International Spine Study Group. (2021) Comparison of patient factors (frailty) vs. surgical factors (invasiveness) for optimization of 2-year cost-utility: we should focus on the patient factors. Spine J 21 Suppl:S105. https://doi.org/10.1016/j.spinee.2021.05.413

  11. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects 2019. https://population.un.org/wpp/publications/files/wpp2019_highlights.pdf. Accessed 8 Sept 2022

  12. Kalseth J, Halvorsen T (2020) Health and care service utilisation and cost over the life-span: a descriptive analysis of population data. BMC Health Serv Res 20:435. https://doi.org/10.1186/s12913-020-05295-2

    Article  PubMed  PubMed Central  Google Scholar 

  13. Garner IW, Varey S, Navarro-Pardo E, Marr C, Holland CA (2022) An observational cohort study of longitudinal impacts on frailty and well-being of COVID-19 lockdowns in older adults in England and Spain. Health Soc Care Commun 30:e2905–e2916. https://doi.org/10.1111/hsc.13735

    Article  Google Scholar 

  14. Yamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, Kikuchi T, Kusumi H, Arai H (2021) The influence of the COVID-19 pandemic on physical activity and new incidence of frailty among initially non-frail older adults in Japan: a follow-up online survey. J Nutr Health Aging 25:751–756. https://doi.org/10.1007/s12603-021-1634-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C, Arora S, Street A, Parker S, Roberts HC, Bardsley M, Conroy S (2018) Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet 391:1775–1782. https://doi.org/10.1016/S0140-6736(18)30668-8

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hannah TC, Neifert SN, Caridi JM, Martini ML, Lamb C, Rothrock RJ, Yuk FJ, Gilligan J, Genadry L, Gal JS (2020) Utility of the hospital frailty risk score for predicting adverse outcomes in degenerative spine surgery cohorts. Neurosurgery 87:1223–1230. https://doi.org/10.1093/neuros/nyaa248

    Article  PubMed  Google Scholar 

  17. Pulido LC, Meyer M, Reinhard J, Kappenschneider T, Grifka J, Weber M (2022) Hospital frailty risk score predicts adverse events in spine surgery. Eur Spine J 31:1621–1629. https://doi.org/10.1007/s00586-022-07211-0

    Article  PubMed  Google Scholar 

  18. Elsamadicy AA, Koo AB, Sarkozy M, David WB, Reeves BC, Patel S, Hansen J, Sandhu MRS, Hengartner AC, Hersh A, Kolb L, Lo SL, Shin JH, Mendel E, Sciubba DM (2022) Leveraging HFRS to assess how frailty affects healthcare resource utilization after Elective ACDF for CSM. Spine J S1529–9430(22):00845–00852. https://doi.org/10.1016/j.spinee.2022.08.004

    Article  Google Scholar 

  19. Kilkenny MF, Phan HT, Lindley RI, Kim J, Lopez D, Dalli LL, Grimley R, Sundararajan V, Thrift AG, Andrew NE, Donnan GA, Cadilhac DA; Stroke123 Investigators and the AuSCR Consortium (2021) Utility of the hospital frailty risk score derived from administrative data and the association with stroke outcomes. Stroke 52:2874–2881. https://doi.org/10.1161/STROKEAHA.120.033648

    Article  Google Scholar 

  20. Subramaniam A, Ueno R, Tiruvoipati R, Srikanth V, Bailey M, Pilcher D (2022) Comparison of the predictive ability of clinical frailty scale and hospital frailty risk score to determine long-term survival in critically ill patients: a multicentre retrospective cohort study. Crit Care 26:121. https://doi.org/10.1186/s13054-022-03987-1

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nachtigall I, Lenga P, Jóźwiak K, Thürmann P, Meier-Hellmann A, Kuhlen R, Brederlau J, Bauer T, Tebbenjohanns J, Schwegmann K, Hauptmann M, Dengler J (2020) Clinical course and factors associated with outcomes among 1904 patients hospitalized with COVID-19 in Germany: an observational study. Clin Microbiol Infect 26:1663–1669. https://doi.org/10.1016/j.cmi.2020.08.011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Dengler J, Prass K, Palm F, Hohenstein S, Pellisier V, Stoffel M, Hong B, Meier-Hellmann A, Kuhlen R, Bollmann A, Rosahl S (2022) Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany. Eur Stroke J 7:166–174. https://doi.org/10.1177/23969873221089152

    Article  PubMed  PubMed Central  Google Scholar 

  23. Abduljawwad N, Pamnani S, Stoffel M, Kraft CN, Hegewald AA, Dörre R, Heese O, Gerlach R, Rosahl S, Maier B, Burger R, Wutzler S, Carl B, Ryang YM, Hau KT, Stein G, Gulow J, Kuhlen R, Hohenstein S, Bollmann A, Dengler J (2023) Effects of the COVID-19 pandemic on spinal fusion procedures for spinal infections in a nationwide hospital network in Germany. J Neurol Surg A Cent Eur Neurosurg 84:58–64. https://doi.org/10.1055/s-0042-1749353

    Article  PubMed  Google Scholar 

  24. Moore BJ, White S, Washington R, Coenen N, Elixhauser A (2017) Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: the AHRQ Elixhauser comorbitiy index. Med Care 55:698–705. https://doi.org/10.1097/MLR.0000000000000735

    Article  PubMed  Google Scholar 

  25. Kane AE, Howlett SE (2021) Sex differences in frailty: Comparisons between humans and preclinical models. Mech Ageing Dev 198:111546. https://doi.org/10.1016/j.mad.2021.111546

    Article  CAS  PubMed  Google Scholar 

  26. Lekan DA, McCoy TP, Jenkins M, Mohanty S, Manda P, Yasin R (2021) Comparison of a frailty risk score and comorbidity indices for hospital readmission using electronic health record data. Res Gerontol Nurs 14:91–103. https://doi.org/10.3928/19404921-20210115-03

    Article  PubMed  Google Scholar 

  27. Baayen RH, Davidson DJ, Bates DM (2008) Mixed-effects modeling with crossed random effects for subjects and items. J Mem Lang 59:390–412. https://doi.org/10.1016/j.jml.2007.12.005

    Article  Google Scholar 

  28. Kliegl R, Masson MEJ, Richter EM (2010) A linear mixed model analysis of masked repetition priming. Vis Cogn 18:655–681. https://doi.org/10.1080/13506280902986058

    Article  Google Scholar 

  29. Bates D, Mächler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1–48. https://doi.org/10.18637/jss.v067.i01

  30. R Core Team (2020) A language and environment for statistical computing. R Foundation for statistical computing. Vienna, Austria

  31. Haffer H, Schömig F, Rickert M, Randau T, Raschke M, Wirtz D, Pumberger M, Perka C (2020) Impact of the COVID-19 pandemic on orthopaedic and trauma surgery in university hospitals in germany: results of a nationwide survey. J Bone Joint Surg Am 102:e78. https://doi.org/10.2106/JBJS.20.00756

    Article  PubMed  Google Scholar 

  32. Soh TLT, Ho SWL, Yap WMQ, Oh JY (2020) Spine Surgery and COVID-19: Challenges and Strategies from the Front Lines. J Bone Joint Surg Am 102:e56. https://doi.org/10.2106/JBJS.20.00503

    Article  PubMed  Google Scholar 

  33. Power FR, Juhdi A, Macken M, Synnott KA, Butler JS (2022) The Impact of COVID-19 and lockdown on spinal services at a national level: lessons learned and areas of service improvement for future health care delivery. Clin Spine Surg 35:7–11. https://doi.org/10.1097/BSD.0000000000001261

    Article  PubMed  Google Scholar 

  34. Arnold PM, Owens L, Heary RF, Webb AG, Whiting MD, Vaccaro AR, Iyer RK, Harrop JS (2021) Lumbar spine surgery and what we lost in the era of the coronavirus pandemic: a survey of the lumbar spine research society. Clin Spine Surg 34:E575-579. https://doi.org/10.1097/BSD.0000000000001235

    Article  PubMed  PubMed Central  Google Scholar 

  35. Abramovic A, Lener S, Grassner L, Thaler M, Pinggera D, Freyschlag CF, Thomé C, Hartmann S (2021) The impact of the COVID-19 pandemic on spine surgery in central Europe: a questionnaire-based study. World Neurosurg 155:e576-587. https://doi.org/10.1016/j.wneu.2021.08.106

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sablerolles RSG, Lafeber M, van Kempen JAL, van de Loo BPA, Boersma E, Rietdijk WJR et al (2021) Association between clinical frailty scale score and hospital mortality in adult patients with COVID-19 (COMET): an international, multicentre, retrospective, observational cohort study. Lancet Healthy Longev 2:e163–e170. https://doi.org/10.1016/S2666-7568(21)00006-4

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zhang XM, Jiao J, Cao J, Huo XP, Zhu C, Wu XJ, Xie XH /2021) Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis. BMC Geriatr 21:186. https://doi.org/10.1186/s12877-021-02138-5

  38. Sealy MJ, van der Lucht F, van Munster BC, Krijnen WP, Hobbelen H, Barf HA, Finnema EJ, Jager-Wittenaar H (2022) Frailty among Older People during the First Wave of the COVID-19 Pandemic in The Netherlands. Int J Environ Res Public Health 19:3669. https://doi.org/10.3390/ijerph19063669

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Robert Koch Institute; Digitales Impfquotenmonitoring zur COVID-19-Impfung. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Daten/Impfquoten-Tab.htm. Accessed 14 Nov 2021

  40. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298. https://doi.org/10.1001/jamasurg.2016.4952

    Article  PubMed  Google Scholar 

  41. Porche K, Yan S, Mohamed B, Garvan C, Samra R, Melnick K, Vaziri S, Seubert C, Decker M, Polifka A, Hoh DJ (2022) Enhanced recovery after surgery (ERAS) improves return of physiological function in frail patients undergoing one- to two-level TLIFs: an observational retrospective cohort study. Spine J 22:1513–1522. https://doi.org/10.1016/j.spinee.2022.04.007

    Article  PubMed  PubMed Central  Google Scholar 

  42. Grieco M, Galiffa G, Marcellinaro R, Santoro E, Persiani R, Mancini S, Di Paola M, Santoro R, Stipa F, Crucitti A, Carlini M, “Lazio Network” study group, (2022) Impact of the COVID-19 Pandemic on Enhanced Recovery After Surgery (ERAS) Application and Outcomes: Analysis in the “Lazio Network” Database. World J Surg 46:2288–2296. https://doi.org/10.1007/s00268-022-06694-8

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tan L, Peng D, Cheng Y. Enhanced Recovery After Surgery Is Still Powerful for Colorectal Cancer Patients in COVID-19 Era. J Laparoendosc Adv Surg Tech A 33:257–262. https://doi.org/10.1089/lap.2022.0393

  44. Prodromidou A, Koulakmanidis AM, Haidopoulos D, Nelson G, Rodolakis A, Thomakos N /2022) Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy. Cancers (Basel) 14:1660 https://doi.org/10.3390/cancers14071660

  45. Partridge JSL, Harari D, Martin FC, Peacock JL, Bell R, Mohammed A, Dhesi JK (2017) Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg 104:679–687. https://doi.org/10.1002/bjs.10459

    Article  CAS  PubMed  Google Scholar 

  46. Hall DE, Arya S, Schmid KK, Carlson MA, Lavedan P, Bailey TL, Purviance G, Bockman T, Lynch TG, Johanning JM (2017) Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg 152:233–240. https://doi.org/10.1001/jamasurg.2016.4219

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was funded by the Helios Center for Research and Innovation via a grant (HCRI ID 2021–0431) to JD.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany

    Julius Dengler, Hussain Gheewala, Ali Allam, Nehad Abduljawwad & Gerardo Rico Gonzalez

  2. Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany

    Julius Dengler, Hussain Gheewala, Nehad Abduljawwad & Gerardo Rico Gonzalez

  3. Department of Orthopedics, Trauma Surgery and Hand Unit, HELIOS Klinikum Krefeld, Krefeld, Germany

    Clayton N. Kraft

  4. Department of Neurosurgery, VAMED Ostsee Hospital Damp, Ostseebad Damp, Germany

    Aldemar A. Hegewald

  5. Department of Neurosurgery, HELIOS Hospital St. Marienberg, Helmstedt, Germany

    Ralf Dörre

  6. Department of Neurosurgery and Spinal Surgery, HELIOS Hospital Schwerin - University Campus of MSH Medical School Hamburg, Schwerin, Germany

    Oliver Heese

  7. Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany

    Rüdiger Gerlach & Steffen Rosahl

  8. Department of Trauma and Orthopedic Surgery, HELIOS Hospital Pforzheim, Pforzheim, Germany

    Bernd Maier

  9. Department of Neurosurgery, HELIOS Hospital Uelzen, Uelzen, Germany

    Ralf Burger

  10. Department of Trauma, Hand and Orthopedic Surgery, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany

    Sebastian Wutzler

  11. Department of Neurosurgery, University of Marburg, Marburg, Germany

    Barbara Carl

  12. Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany

    Barbara Carl

  13. Department of Neurosurgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany

    Barbara Carl

  14. Department of Neurosurgery and Spine Center, HELIOS Hospital Berlin Buch, Berlin, Germany

    Yu-Mi Ryang

  15. Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany

    Yu-Mi Ryang

  16. Department of Spine Surgery, HELIOS Hospital Duisburg, Duisburg, Germany

    Khanh Toan Hau

  17. Department of Orthopaedic, Trauma and Spine Surgery, HELIOS Hospital Siegburg, Siegburg, Germany

    Gregor Stein

  18. Department of Spine Surgery, HELIOS Park-Klinikum Leipzig, Leipzig, Germany

    Jens Gulow

  19. Department of Anesthesiology and Intensive Care Medicine, HELIOS Hospital Bad Saarow, Bad Saarow, Germany

    Ali Allam

  20. HELIOS Health GmbH, Berlin, Germany

    Ralf Kuhlen

  21. Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany

    Sven Hohenstein & Andreas Bollmann

  22. Department of Electrophysiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany

    Andreas Bollmann

  23. Department of Neurosurgery, HELIOS Hospital Krefeld, Krefeld, Germany

    Michael Stoffel

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  1. Julius Dengler
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Contributions

JD and MS conceived the study, wrote the first draft of the manuscript, and were involved in data interpretation. JD, HG, CNK, AAH, RD, OH, RG, SR, BM, RB, SW, BC, YR, KTH, GS, JG, AA, NA, GRG, and MS were involved in the collection of data. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Julius Dengler.

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Conflict of interests

JD received funding through the Helios Center for Research and Innovation via a grant (HCRI ID 2020–0458). RK holds shares in Fresenius AG. YR is a member of the DWG Advisory Board for the journal “Die Wirbelsäule, DWG Commissions (Science, Education, Quality Safety, Congress Program), and Eurospine EduCom.” All other authors declare no conflict of interest.

Ethics approval

The study was approved by the ethics committee of the University of Leipzig on February 07, 2022 (490/20-ek).

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Informed consent was waived due to the retrospective design of this study.

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Dengler, J., Gheewala, H., Kraft, C.N. et al. Changes in frailty among patients hospitalized for spine pathologies during the COVID-19 pandemic in Germany—a nationwide observational study. Eur Spine J 33, 19–30 (2024). https://doi.org/10.1007/s00586-023-08014-7

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