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The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery

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Abstract

Purpose

This study evaluates the influence of patient frailty status on postoperative complications in those receiving single-level lumbar fusion surgery.

Methods

The nationwide readmission database was retrospectively queried between 2016 and 2017 for all patients receiving single-level lumbar fusion surgery. Readmissions were analyzed at 30, 90, and 180 days from primary discharge. Demographics, frailty status, and relevant complications were queried at index admission and all readmission intervals. Complications of interest included infection, urinary tract infection (UTI), posthemorrhagic anemia, inpatient length of stay (LOS), and adjusted all-payer costs. Nearest-neighbor propensity score matching for demographics was implemented to identify non-frail control patients with similar diagnoses and procedures. The analysis used nonparametric Mann–Whitney U testing and odds ratios.

Results

Comparing propensity-matched cohorts revealed significantly greater LOS and total all-payer inpatient costs in frail patients than non-frail patients with comparable demographics and comorbidities (p < 0.0001 for both). Furthermore, frail patients encountered higher rates of UTI (OR: 3.97, 95%CI: 3.21–4.95, p < 0.0001), infection (OR: 6.87, 95%CI: 4.55–10.86, p < 0.0001), and posthemorrhagic anemia (OR: 1.94, 95%CI: 1.71–2.19, p < 0.0001) immediately following surgery. Frail patients had significantly higher rates of 30-day (OR: 1.24, 95%CI: 1.02–1.51, p = 0.035), 90-day (OR: 1.38, 95%CI: 1.17–1.63, p < 0.001), and 180-day (OR: 1.55, 95%CI: 1.30–1.85, p < 0.0001) readmissions. Lastly, frail patients had higher rates of infection at 30-day (OR: 1.61, 95%CI: 1.05–2.46, p = 0.027) and 90-day (OR: 1.51, 95%CI: 1.07–2.16, p = 0.020) readmission intervals.

Conclusions

Patient frailty status may serve as an important predictor of postoperative outcomes in patients receiving single-level lumbar fusion surgery.

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Data availability

No patient identifiers were collected, as we used a publicly available nationally representative database purchased through the Healthcare Cost and Utilization Project website. No unique code was developed, and standard statistical software (RStudio) and tests were used.

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Funding

No sources of funding were used for this study.

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Author notes

  1. Shane Shahrestani and Andy Ton have contributed equally.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, 1450 San Pablo St., HC4- Suite 5400A, Los Angeles, CA, USA

    Shane Shahrestani, Andy Ton, Xiao T. Chen, Alexander M. Ballatori, Jeffrey C. Wang & Zorica Buser

  2. Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA

    Shane Shahrestani

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  1. Shane Shahrestani
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  2. Andy Ton
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Corresponding author

Correspondence to Zorica Buser.

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Conflict of interest

No conflicts of interest for the current study. Disclosures outside of submitted work: ZB-consultancy: Cerapedics (past), Xenco Medical (past), AO Spine (past); Research Support: SeaSpine (past, paid to the institution), Medical Metrics (paid directly to institution), Next Science (paid directly to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Education committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee-committee member; JCW- Royalties—Biomet, Seaspine, Amedica, DePuy Synthes; Investments/Options—Bone Biologics, Pearldiver, Electrocore, Surgitech; Board of Directors—AO Foundation, American Orthopaedic Association, Society for Brain Mapping and Therapeutics; Editorial Boards—Spine, The Spine Journal, Clinical Spine Surgery, Global Spine Journal; Fellowship Funding (paid directly to institution): AO Foundation.

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Shahrestani, S., Ton, A., Chen, X.T. et al. The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery. Eur Spine J 30, 3755–3762 (2021). https://doi.org/10.1007/s00586-021-06960-8

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  • DOI: https://doi.org/10.1007/s00586-021-06960-8

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