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
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Funding
Funding for the European Spine Study Group database was provided by DePuy Synthes.
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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.
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Miller, E.K., Vila-Casademunt, A., Neuman, B.J. et al. External validation of the adult spinal deformity (ASD) frailty index (ASD-FI). Eur Spine J 27, 2331–2338 (2018). https://doi.org/10.1007/s00586-018-5575-3
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DOI: https://doi.org/10.1007/s00586-018-5575-3