Kweh Barry, Lee Hui, Tan Terence, O'Donohoe Tom, Mathew Joseph, Fitzgerald Mark, Gantner Dashiell, Kambourakis Tony, Tew Kim, Hunn Martin, Rosenfeld Jeffrey, Tee Jin
National Trauma Research Institute (NTRI), Melbourne, Australia.
5392Alfred Health, Melbourne, Australia.
Global Spine J. 2021 May;11(4):525-532. doi: 10.1177/2192568220914877. Epub 2020 Mar 30.
This was an ambispective clinical quality registry study.
To evaluate utility of 11-variable modified Frailty Index (mFI) in predicting postoperative outcomes among patients ≥80 years undergoing spinal surgery.
Consecutive patients ≥80 years who underwent spinal surgery between January 1, 2013, and June 30, 2018, were included. Primary outcome measure was rate of major complication. Secondary outcome measures were (1) overall complication rate, (2) surgical site infection, and (3) 6-month mortality.
A total of 121 operations were performed. Demographic metrics were (1) age (mean ± SD) = 83.1 ± 2.8 years and (2) mFI (mean ± SD) = 2.1 ± 1.4 variables. As mFI increased from 0 to ≥4 variables, risk of major complication increased from 18.2% to 40.0% ( = .014); overall complication increased from 45.5% to 70.0% ( = .032); surgical site infection increased from 0.0% to 25.0% ( = .007). There were no significant changes in risk of 6-month mortality across mFIs ( = .115). Multivariate analysis showed that a higher mFI score of ≥3 variables was associated with a significantly higher risk of (1) major complication ( = .025); (2) overall complication ( = .015); (3) surgical site infection ( = .007); and (4) mortality ( = .044).
mFI scores of ≥3/11 variables were associated with a higher risk of postoperative morbidity in patients aged ≥80 years undergoing spinal surgery. The mFI-associated risk stratification provides a valuable adjunct in surgical decision making for this rapidly growing subpopulation of patients.
这是一项回顾性和前瞻性相结合的临床质量登记研究。
评估11变量改良衰弱指数（mFI）在预测80岁及以上接受脊柱手术患者术后结局中的效用。
纳入2013年1月1日至2018年6月30日期间连续接受脊柱手术的80岁及以上患者。主要结局指标是严重并发症发生率。次要结局指标包括：（1）总体并发症发生率；（2）手术部位感染；（3）6个月死亡率。
共进行了121例手术。人口统计学指标为：（1）年龄（均值±标准差）=83.1±2.8岁；（2）mFI（均值±标准差）=2.1±1.4个变量。随着mFI从0增加到≥4个变量，严重并发症风险从18.2%增加到40.0%（P=0.014）；总体并发症从45.5%增加到70.0%（P=0.032）；手术部位感染从0.0%增加到25.0%（P=0.007）。不同mFI水平的6个月死亡率风险无显著变化（P=0.115）。多因素分析显示，mFI得分≥3个变量与以下风险显著升高相关：（1）严重并发症（P=0.025）；（2）总体并发症（P=0.015）；（3）手术部位感染（P=0.007）；（4）死亡率（P=0.044）。
在80岁及以上接受脊柱手术的患者中，mFI得分≥3/11个变量与术后发病风险较高相关。mFI相关的风险分层为这一快速增长的患者亚群的手术决策提供了有价值的辅助手段。
