Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan.
Spine (Phila Pa 1976). 2019 Sep;44(18):E1083-E1091. doi: 10.1097/BRS.0000000000003063.
A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 ± 19 yrs, 91% female, follow-up 4.3 ± 1.9 yrs) from a multicenter database.
To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs).
Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven.
SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients' frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients.
Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to ≥2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3-3.7).
The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients.
回顾性分析了来自多中心数据库的 281 例成人脊柱畸形（ASD）手术的连续病例（年龄 55±19 岁，91%为女性，随访 4.3±1.9 年）。
比较 5 项简化衰弱指数（mFI-5）与传统 11 项简化衰弱指数（mFI-11）对严重不良事件（SAE）的价值和预测能力。
最近的几项研究描述了衰弱与手术并发症之间的关联。然而，mFI-5 的预测能力和实用性尚未得到证实。
SAE 定义为：Clavien-Dindo 分级>3，需要再次手术，出院时运动功能恶化，或 2 年内出现新的运动功能障碍。患者的衰弱程度通过 mFI-5 和 mFI-11（强壮、虚弱前期或虚弱）进行分类。采用 Spearman's rho 评估 mFI-5 和 mFI-11 之间的相关性。采用单变量和多变量 Poisson 回归分析，分析 mFI-5 和 mFI-11 作为 ASD 手术 SAE 预测因子的相对风险。年龄、性别和基线矢状面排列（Schwab-SRS 分类亚类）用于调整患者的基线方差。
281 例患者中，2 年内有 63 例（22%）发生 SAE。mFI-5 和 mFI-11 之间的加权 Kappa 比值为 0.87，表明 ASD 手术中存在良好的一致性。衰弱与总并发症、围手术期并发症、植入物相关并发症和 SAE 有关。调整和未调整模型均显示 mFI-5 和 mFI-11 的 C 统计量相似，对 ASD 手术的 SAE 具有较强的预测能力。随着 mFI-5 从 0 增加到≥2，SAE 的发生率从 17%增加到 63%（P<0.01），相对风险为 2.2（95%CI：1.3-3.7）。
mFI-5 和 mFI-11 是 ASD 手术中 SAE 发展的同等有效预测因子。使用 mFI-5 评估患者的衰弱状况有助于外科医生优化手术程序并为患者提供咨询。
4 级。
