Reid Daniel B C, Daniels Alan H, Ailon Tamir, Miller Emily, Sciubba Daniel M, Smith Justin S, Shaffrey Christopher I, Schwab Frank, Burton Douglas, Hart Robert A, Hostin Richard, Line Breton, Bess Shay, Ames Christopher P
Department of Orthopedics, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA.
Department of Orthopedics, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA.
World Neurosurg. 2018 Apr;112:e548-e554. doi: 10.1016/j.wneu.2018.01.079. Epub 2018 Jan 31.
Although the Adult Spinal Deformity Frailty Index (ASD-FI) predicts major complications and prolonged hospital length of stay after adult spinal deformity surgery, the impact of frailty on postoperative changes in health-related quality of life (HRQoL) is unknown.
Patients who underwent instrumented fusion of ≥4 levels for adult spinal deformity with minimum 2-year follow-up were stratified by Adult Spinal Deformity Frailty Index score into 3 groups: nonfrail, frail, and severely frail. Baseline and follow-up demographics, HRQoL measures, and radiographic parameters were analyzed. Primary outcome measures included proportion of patients who achieved substantial clinical benefit (SCB) in terms of Oswestry Disability Index, 36-Item Short Form Health Survey Physical Component Summary, and numeric back and leg pain scores.
Inclusion criteria were met by 332 patients (135 nonfrail, 175 frail, 22 severely frail). Frail and severely frail patients were older and had more comorbidities, worse baseline HRQoL and pain scores, and worse radiographic deformity than nonfrail patients (P < 0.05). At 2-year follow-up, all outcome scores were worse in frail and severely frail patients compared with nonfrail patients. Frail patients improved more than nonfrail patients and were more likely to reach SCB for Oswestry Disability Index (43.7% vs. 29.3%; P = 0.025), 36-Item Short Form Health Survey Physical Component Summary (56.9% vs. 51.2%; P = 0.03), and leg pain (45.8% vs. 23.0%; P = 0.03) scores, but not back pain (57.5% vs. 63.4%; P = 0.045) score.
Despite higher risk stratification and worse baseline HRQoL, frail patients were more likely to reach SCB for most HRQoL measures compared with nonfrail patients. Severely frail patients were the least likely to reach SCB for most HRQoL measures.
尽管成人脊柱畸形虚弱指数（ASD-FI）可预测成人脊柱畸形手术后的主要并发症及延长的住院时间，但虚弱对术后健康相关生活质量（HRQoL）变化的影响尚不清楚。
对接受≥4节段器械融合治疗成人脊柱畸形且随访至少2年的患者，根据成人脊柱畸形虚弱指数评分分为3组：非虚弱组、虚弱组和严重虚弱组。分析基线和随访时的人口统计学数据、HRQoL指标及影像学参数。主要结局指标包括在奥斯威斯利残疾指数、36项简短健康调查身体成分总结以及背部和腿部疼痛数字评分方面达到显著临床获益（SCB）的患者比例。
332例患者（135例非虚弱，175例虚弱，22例严重虚弱）符合纳入标准。与非虚弱患者相比，虚弱和严重虚弱患者年龄更大，合并症更多，基线HRQoL和疼痛评分更差，影像学畸形更严重（P<0.05）。在2年随访时，与非虚弱患者相比，虚弱和严重虚弱患者的所有结局评分更差。虚弱患者比非虚弱患者改善更多，更有可能在奥斯威斯利残疾指数（43.7%对29.3%；P = 0.025）、36项简短健康调查身体成分总结（56.9%对51.2%；P = 0.03）以及腿部疼痛（45.8%对23.0%；P = 0.03）评分方面达到SCB，但在背痛（57.5%对63.4%；P = 0.045）评分方面未达到。
尽管风险分层更高且基线HRQoL更差，但与非虚弱患者相比，虚弱患者在大多数HRQoL指标上更有可能达到SCB。严重虚弱患者在大多数HRQoL指标上最不可能达到SCB。
