Department of Neurosurgery, Mount Sinai Icahn School of Medicine, 1468 Madison Ave, New York, NY 10029, USA.
Department of Anesthesiology, Mount Sinai Icahn School of Medicine, 1468 Madison Ave, New York, NY 10029, USA.
Spine J. 2019 Jan;19(1):104-112. doi: 10.1016/j.spinee.2018.05.026. Epub 2018 May 21.
As increasing numbers of elderly Americans undergo spinal surgery, it is important to identify which patients are at highest risk for poor cognitive and functional recovery. Frailty is a geriatric syndrome that has been closely linked to poor outcomes, and short-form screening may be a helpful tool for preoperative identification of at-risk patients.
This study aimed to conduct a pilot study on the usefulness of a short-form screening tool to identify elderly patients at increased risk for prolonged cognitive and functional recovery following elective spine surgery.
STUDY DESIGN/SETTING: This is a prospective, comparative cohort study.
The sample comprised 100 patients over age 65 who underwent elective spinal surgery (cervical or lumbar) at a single, large academic medical center from 2013 to 2014.
Fatigue, Resistance, Ambulation, Illnesses, Loss of Weight (FRAIL) scale, Postoperative Quality of Recovery Scale (PQRS), and instrumental activities of daily living (IADL) scores were the outcome measures.
Included patients were assessed with the FRAIL scale and stratified as robust, pre-frail, or frail. The PQRS and IADL scores were also obtained. Patients were re-examined at 1 day, 3 days, 1 month, and 3 months after surgery for cognitive recovery at 3 months, and secondarily, functional recovery at 3 months.
At 3 months, only 50% of frail patients had recovered to their cognitive baseline compared with 60.7% of pre-frail and 69.2% of robust patients (trend). At 3 months, 66.7% of frail patients had recovered to their functional baseline compared with 57% of pre-frail and 76.9% of robust patients (trend). Using multivariate regression modeling, at 3 months, frail patients were less likely to have recovered to their cognitive baseline compared with pre-frail and robust patients (odds ratio 0.39, confidence interval 0.131-1.161).
This pilot study demonstrates a trend toward poorer cognitive recovery 3 months following elective spinal surgery for frail patients. Frailty screening can help preoperatively identify patients who may experience protracted cognitive and functional recovery.
随着越来越多的美国老年人接受脊柱手术，确定哪些患者面临认知和功能恢复不良的风险最高变得非常重要。衰弱是一种与不良预后密切相关的老年综合征，而简短的筛查可能是术前识别高危患者的有用工具。
本研究旨在对一种简短的筛查工具的有用性进行试点研究，以确定接受择期脊柱手术后认知和功能恢复时间延长的老年患者。
研究设计/地点：这是一项前瞻性比较队列研究。
该样本包括 2013 年至 2014 年期间在一家大型学术医疗中心接受择期脊柱手术（颈椎或腰椎）的 100 名 65 岁以上的患者。
疲劳、抵抗、活动能力、疾病、体重减轻（衰弱）量表、术后恢复质量量表（PQRS）和工具性日常生活活动（IADL）评分是结果测量。
纳入的患者接受了衰弱量表评估，并分为强壮、衰弱前期或衰弱。还获得了 PQRS 和 IADL 评分。患者在手术后 1 天、3 天、1 个月和 3 个月进行复查，以评估术后 3 个月的认知恢复情况，其次是术后 3 个月的功能恢复情况。
术后 3 个月，只有 50%的衰弱患者恢复到认知基线，而衰弱前期患者为 60.7%，强壮患者为 69.2%（趋势）。术后 3 个月，66.7%的衰弱患者恢复到功能基线，而衰弱前期患者为 57%，强壮患者为 76.9%（趋势）。使用多变量回归模型，术后 3 个月，衰弱患者恢复到认知基线的可能性低于衰弱前期和强壮患者（比值比 0.39，95%置信区间 0.131-1.161）。
这项试点研究表明，虚弱患者在接受择期脊柱手术后 3 个月认知恢复较差。衰弱筛查可以帮助术前识别可能经历认知和功能恢复延长的患者。
