Department of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA.
Department of Orthopaedic Surgery, Columbia University, New York, NY.
Spine (Phila Pa 1976). 2018 Oct 15;43(20):1426-1431. doi: 10.1097/BRS.0000000000002717.
Analysis of a prospective multicenter database.
To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index.
Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery.
Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3-0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay.
The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients.
Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures.
前瞻性多中心数据库分析。
评估最近创建的成人脊柱畸形（ASD）虚弱指数（ASD-FI）预测接受更严重术前畸形和更具侵袭性 ASD 手术的患者发生主要并发症和住院时间的能力，与用于创建该指数的数据库中的患者相比。
鉴于目前与 ASD 手术相关的高并发症发生率，需要进行准确的术前风险评估。
欧洲、亚洲和北美的参与机构在 2009 年至 2011 年间招募了患者。使用 ASD-FI 评分将 267 名患者分为非虚弱（NF）（<0.3）、虚弱（0.3-0.5）或严重虚弱（SF）（>0.5）。进行多变量逻辑回归，调整术前和手术相关因素，如手术时间和失血量，以确定 ASD-FI 类别与主要并发症发生率、总体并发症发生率和住院时间之间的关系。
平均 ASD-FI 评分为 0.3（范围，0-0.7）。我们将 105 名患者归类为 NF，103 名归类为虚弱，59 名归类为 SF。SF 患者发生重大并发症的调整后优势比（OR）为 4.4（95%CI，2.0，9.9），高于 NF 患者。在调整了混杂因素后，SF 患者的住院时间增加了 19%（95%CI，1.4%，39%），与 NF 患者相比。虚弱和 NF 患者的主要并发症发生率或住院时间延长的几率相似。
ASD-FI 测量的患者虚弱程度越高，与术前严重畸形和接受侵袭性手术的患者住院时间延长和发生重大并发症的风险增加相关。
2 级。
