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Is frailty responsive to surgical correction of adult spinal deformity? An investigation of sagittal re-alignment and frailty component drivers of postoperative frailty status

Abstract

Purpose

Frailty has been associated with adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity was developed. Components of the ASD-FI utilize patient comorbidity, clinical symptoms, and patient-reported-outcome-measures (PROMS). Our purpose was to investigate components of the Adult Spinal Deformity Frailty Index (ASD-FI) responsive to surgery and drivers of overall frailty.

Methods

Operative ASD patients ≥ 18 years, undergoing multilevel fusions, with complete baseline, 6 W, 1Y and 2Y ASD-FI scores. Descriptive analysis assessed demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t tests assessed postoperative changes to ASD-FI components, total score, and radiographic parameters. Linear regression models determined the effect of successful surgery (achieving lowest level SRS-Schwab classification modifiers) on change in ASD-FI total scores.

Results

409 6-week, 696 1-year, and 253 2-year operative ASD patients were included. 6-week and 1-year baseline frailty scores were 0.34, 2 years was 0.38. Following surgery, 6-week frailty was 0.36 (p = 0.033), 1 year was 0.25 (p < 0.001), and 2 years was 0.28 (p < 0.001). Of the ASD-FI variables, 17/40 improved at 6 weeks, 21/40 at 1 year, and 18/40 at 2 years. Successful surgery significantly predicted decreases in 1-year frailty scores (R = 0.27, p < 0.001), SRS-Schwab SVA modifier was the greatest predictor (Adjusted Beta: − 0.29, p < 0.001).

Conclusions

Improvement in sagittal realignment and functional status correlated with improved postoperative frailty. Additional research and deformity sub-group analyses are needed to describe associations between specific functional activities that correlated with frailty improvement as well as evaluation of modifiable and non-modifiable indices.

Level of evidence

3.

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Funding

The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations, and supported the current work.

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Contributions

PGP, FAS, KAM, RL, JSS, BGL, RKE, DCB, RAH, SB, CIS, CPA, VL, ISSG: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. PGP, FAS, KAM, RL, JSS, BGL, RKE, DCB, RAH, SB, CIS, CPA, VL, ISSG: drafted the work or revised it critically for important intellectual content. PGP, FAS, KAM, RL, JSS, BGL, RKE, DCB, RAH, SB, CIS, CPA, VL, ISSG: approved the version to be published. PGP, FAS, KAM, RL, JSS, BGL, RKE, DCB, RAH, SB, CIS, CPA, VL, ISSG: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy of integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Peter G. Passias.

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Conflict of interest

Dr. Peter G. Passias has received financial or research support from Allosource, Cervical Scoliosis Research Society, and the International Spine Study Group (ISSG), consulting fees from Globus Medical, Medtronic, Royal Biologics SpineWave, Terumo, and Zimmer, and is on the editorial board for Spine and Journal of Neurosurgery: Spine. Dr. Justin S. Smith is a paid consultant for Carlsmed, Cerapedics, DePuy, Nuvasive, Stryker, and Zimmer, receives research support from DePuy, Nuvasive, Thieme and the ISSG, royalties from Thieme and Nuvasive, stock from Alphatec, and is a board member for Journal of Neurosurgery: Spine, Neurosurgery, ISSG, Operative Neurosurgery, the Scoliosis Research Society, and Spine Deformity. Renaud Lafage receives research support from the ISSG and stock from Nemaris. Virginie Lafage is a paid consultant for Globus Medical, DePuy, and the Permanente Medical Group, receives research support from the ISSG, royalties from Nuvasive, and is a board member for European Spine Journal, the Scoliosis Research Society, and the ISSG. Breton G. Line is a paid consultant and receives research support from the ISSG. Robert K. Eastlack is a paid consultant for Carevature, Aesculap/B.Braun, Baxter, Biedermann-Motech, Medtronic, Nuvasive, Radius, Seaspine, SI Bone, and Stryker, receives research support from Nuvasive and the ISSG, royalties from Globus Medical, Seaspine, SI Bone and Nuvasive, stock from Alphatec, Spine Innovations, Seaspine, Nuvasive, Invuity, Nocimed and Carevature, and is a board member for San Diego Spine Foundation, the Scoliosis Research Society, Society of Lateral Access Surgery, and the ISSG. Douglas C. Burton is a paid consultant for DePuy, receives research support from Bioventus, DePuy, Pfizer and the ISSG, royalties from DePuy, stock from Progenerative Medical, and is a board member for the Scoliosis Research Society, Spine Deformity, and the ISSG. Robert A. Hart is a paid consultant for DePuy, Globus Medical, Medtronic, and Orthofix, receives research support from the ISSG, stock from Spine Connect, and is a board member for the Scoliosis Research Society, Western Orthopaedic Association, American Orthopaedic Association, Cervical Spine Research Society, ISSLS Textbook of the Lumbar Spine, North American Spine Society, and the ISSG. Shay Bess is a paid consultant for Allosource, DePuy, K2 Medical, and Stryker, receives research support from Allosource, Biomet, DePuy, Globus Medical, EOS, K2 Medical, Medtronic, Nuvasive, Orthofix, and the ISSG, royalties from Nuvasive and K2 Medical, and is a board member for the Scoliosis Research Society, North American Spine Society, and the ISSG. Christopher I. Shaffrey is a paid consultant for DePuy, Medtronic, Nuvasive, and Proprio, receives research support from DePuy, Globus Medical, Medtronic, Nuvasive, and the ISSG, royalties from Medtronic, SI Bone, and Nuvasive, stock from Nuvasive, and is a board member for the Scoliosis Research Society, Spine, Spine Deformity, Cervical Spine Research Society, AANS, Neurosurgery, and the ISSG. Christopher P. Ames is a paid consultant for DePuy, K2 Medical, Medicrea, Medtronic, receives research support from DePuy, Titan Spine, Scoliosis Research Society, and the ISSG, royalties from DePuy, Medicrea, Next Orthosurgical and Stryker, stock from Nuvasive, and is a board member for the Scoliosis Research Society, Global Spine Analytics, Operative Neurosurgery, and the ISSG. Remaining authors declare that they have no conflict of interest.

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Each institution obtained approval from their local Institutional Review Board, in which this study was deemed exempt due to the de-identified nature of the data.

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Passias, P.G., Segreto, F.A., Moattari, K.A. et al. Is frailty responsive to surgical correction of adult spinal deformity? An investigation of sagittal re-alignment and frailty component drivers of postoperative frailty status. Spine Deform 10, 901–911 (2022). https://doi.org/10.1007/s43390-022-00476-x

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  • DOI: https://doi.org/10.1007/s43390-022-00476-x

Keywords

  • Adult spinal deformity
  • Spine surgery
  • Realignment
  • Frailty
  • Frailty Index
  • Sagittal realignment
  • Health related quality of life
  • PROMS
  • Adult Spinal Deformity Frailty Index
  • SRS-Schwab Adult Spinal Deformity Classification