Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY.
Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York.
Spine (Phila Pa 1976). 2020 Apr 1;45(7):E397-E405. doi: 10.1097/BRS.0000000000003288.
STUDY DESIGN: Retrospective review of a prospective database. OBJECTIVE: The aim of this study was to evaluate postop clinical recovery among adult spinal deformity (ASD) patients between frailty states undergoing primary procedures SUMMARY OF BACKGROUND DATA.: Frailty severity may be an important determinant for impaired recovery after corrective surgery. METHODS: It included ASD patients with health-related quality of life (HRQLs) at baseline (BL), 1 year (1Y), and 3 years (3Y). Patients stratified by frailty by ASD-frailty index scale 0-1(no frailty: <0.3 [NF], mild: 0.3-0.5 [MF], severe: >0.5 [SF]). Demographics, alignment, and SRS-Schwab modifiers were assessed with χ/paired t tests to compare HRQLs: Scoliosis Research Society 22-question Questionnaire (SRS-22), Numeric Rating Scale (NRS) Back/Leg Pain, Oswestry Disability Index (ODI). Area-under-the-curve (AUC) method generated normalized HRQL scores at baseline (BL) and f/u intervals (1Y, 3Y). AUC was calculated for each f/u, and total area was divided by cumulative f/u, generating one number describing recovery (Integrated Health State [IHS]). RESULTS: A total of 191 patients were included (59 years, 80% females). Breakdown of patients by frailty status: 43.6% NF, 40.8% MF, 15.6% SF. SF patients were older (P = 0.003), >body mass index (P = 0.002). MF and SF were significantly (P < 0.001) more malaligned at BL: pelvic tilt (NF: 21.6°; MF: 27.3°; SF: 22.1°), pelvic incidence and lumbar lordosis (7.4°, 21.2°, 19.7°), sagittal vertical axis (31 mm, 87 mm, 82 mm). By SRS-Schwab, NF were mostly minor (40%), and MF and SF markedly deformed (64%, 57%). Frailty groups exhibited BL to 3Y improvement in SRS-22, ODI, NRS Back/Leg (P < 0.001). After HRQL normalization, SF had improvement in SRS-22 at year 1 and year 3 (P < 0.001), and NRS Back at 1Y. 3Y IHS showed a significant difference in SRS-22 (NF: 1.2 vs. MF: 1.32 vs. SF: 1.69, P < 0.001) and NRS Back Pain (NF: 0.52, MF: 0.66, SF: 0.6, P = 0.025) between frailty groups. SF had more complications (79%). SF/marked deformity had larger invasiveness score (112) compared to MF/moderate deformity (86.2). Controlling for baseline deformity and invasiveness, SF showed more improvement in SRS-22 IHS (NF: 1.21, MF: 1.32, SF: 1.66, P < 0.001). CONCLUSION: Although all frailty groups exhibited improved postop disability/pain scores, SF patients recovered better in SRS-22 and NRS Back. Despite SF patients having more complications and larger invasiveness scores, they had overall better patient-reported outcomes, signifying that with frailty severity, patients have more room for improvement postop compared to BL quality of life. LEVEL OF EVIDENCE: 3.
研究设计：前瞻性数据库的回顾性研究。 目的：本研究旨在评估成年脊柱畸形（ASD）患者在进行初次手术时，虚弱状态与术后临床恢复之间的关系。 背景资料概要：虚弱严重程度可能是矫正手术后恢复不良的重要决定因素。 方法：纳入基线（BL）、1 年（1Y）和 3 年（3Y）时具有健康相关生活质量（HRQL）的 ASD 患者。患者根据 ASD 虚弱指数量表分为 0-1 级（无虚弱：<0.3 [NF]，轻度：0.3-0.5 [MF]，重度：>0.5 [SF]）。使用 χ/配对 t 检验评估人口统计学、对齐和 SRS-Schwab 修正因子，以比较 HRQL：脊柱研究协会 22 项问卷（SRS-22）、数字评分量表（NRS）背部/腿部疼痛、Oswestry 残疾指数（ODI）。生成基线（BL）和随访间隔（1Y、3Y）的归一化 HRQL 评分的 AUC 方法。计算每个随访的 AUC，并将总区域除以累积随访，生成一个描述恢复的数字（综合健康状况 [IHS]）。 结果：共纳入 191 例患者（年龄 59 岁，80%为女性）。根据虚弱状态对患者进行分组：43.6% NF，40.8% MF，15.6% SF。SF 患者年龄更大（P=0.003），体重指数更高（P=0.002）。MF 和 SF 在 BL 时明显（P<0.001）更不平衡：骨盆倾斜（NF：21.6°；MF：27.3°；SF：22.1°），骨盆入射角和腰椎前凸（7.4°、21.2°、19.7°），矢状垂直轴（31mm、87mm、82mm）。根据 SRS-Schwab，NF 大多为轻度（40%），MF 和 SF 明显变形（64%、57%）。虚弱组在 BL 至 3Y 时 SRS-22、ODI、NRS 背部/腿部疼痛均有改善（P<0.001）。在 HRQL 归一化后，SF 在 1 年和 3 年时 SRS-22 有改善（P<0.001），1 年时 NRS 背部疼痛有改善。3Y IHS 在 SRS-22（NF：1.2 与 MF：1.32 与 SF：1.69，P<0.001）和 NRS 背部疼痛（NF：0.52、MF：0.66、SF：0.6、P=0.025）方面显示出虚弱组之间有显著差异。SF 组并发症更多（79%）。SF/明显变形的侵袭性评分（112）高于 MF/中度变形（86.2）。控制基线畸形和侵袭性，SF 在 SRS-22 IHS 方面显示出更多的改善（NF：1.21、MF：1.32、SF：1.66，P<0.001）。 结论：尽管所有虚弱组术后残疾/疼痛评分均有改善，但 SF 患者在 SRS-22 和 NRS 背部方面恢复更好。尽管 SF 患者并发症更多，侵袭性评分更高，但总体上患者报告的结果更好，这表明随着虚弱严重程度的增加，患者术后生活质量较基线有更大的改善空间。 证据水平：3。
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