Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2019 Feb 1;44(3):169-176. doi: 10.1097/BRS.0000000000002778.
Retrospective review.
Develop a simplified frailty index for cervical deformity (CD) patients.
To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary.
CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: Not Frail (NF, <0.3), Frail (0.3-0.5), Severely Frail (SF, >0.5). Means comparison tests established correlations between frailty category and clinical outcomes.
Included: 121 CD patients (61 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]).
Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.
回顾性研究。
为颈椎畸形（CD）患者开发简化的衰弱指数。
为了提高手术 CD 患者的术前风险分层，开发了一种包含 40 种健康缺陷的 CD 衰弱指数（CD-FI）。虽然是新颖的，但由于计算所需的因素数量庞大，CD-FI 在临床上不切实际。为了提高临床实用性，需要更简单的改良 CD-FI（mCD-FI）。
CD 患者（C2-C7 Cobb>10°，CL>10°，cSVA>4cm 或 CBVA>25°）>18 岁，有术前 CD-FI 成分因素。Pearson 双变量相关分析评估了 CD-FI 各组成部分缺陷与整体 CD-FI 评分之间的关系。对导致 CD-FI 评分的主要缺陷进行多元逐步回归模型分析。从具有最大 R 的模型中排除缺陷，并计算所有缺陷的平均评分，从而得出 mCD-FI 评分（0 至 1）。根据 mCD-FI 将患者分层：非虚弱（NF，<0.3）、虚弱（0.3-0.5）、严重虚弱（SF，>0.5）。均值比较检验确定了虚弱类别与临床结果之间的相关性。
纳入 121 例 CD 患者（61±11 岁，60%为女性）。多元逐步回归模型确定了 15 种缺陷是 CD-FI 变异的 86%原因；这些因素被用于构建 mCD-FI。总体而言，mCD-FI 的平均值为 0.31±0.14。按 mCD-FI 类别划分的患者分布：NF：47.9%，虚弱：46.3%，SF：5.8%。与 NF 和虚弱患者相比，SF 患者的住院时间最长（P=0.042），基线颈痛更严重（P=0.033），颈部残疾指数评分（P<0.001）和 EQ-5D 评分（P<0.001）更差。虚弱患者发生浅表感染的几率更高（OR：1.1[1.0-1.2]），SF 患者的死亡率更高（OR：8.3[1.3-53.9]）。
mCD-FI 评估的衰弱程度与住院时间延长、颈痛加重和健康相关生活质量下降相关。虚弱患者感染风险增加，严重虚弱患者死亡风险增加。衰弱与临床结果之间的这种关系表明，mCD-FI 作为术前风险分层工具具有临床实用性。
3 级。
