Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
The Wolff Center at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Neurosurgery. 2021 Feb 16;88(3):552-557. doi: 10.1093/neuros/nyaa468.
With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events.
To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease.
As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data.
From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions.
Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.
随着人口老龄化，患有多种合并症的老年患者越来越多地接受脊柱手术，并且可能面临更高的并发症风险。虚弱的客观测量可能预测术后不良事件的发生。
研究术前虚弱与术后脊柱手术结果之间的关系，包括死亡率、住院时间、再入院、手术部位感染和静脉血栓栓塞疾病。
作为一项系统范围的质量改进计划的一部分，从 2016 年 7 月开始，在考虑脊柱手术的患者的常规评估中增加了虚弱评估。使用风险分析指数（RAI）评估虚弱，将患者分为非虚弱（RAI 0-29）或虚弱/易患（RAI≥30）。使用 Fisher 精确检验对分类数据或 Wilcoxon 秩和检验对连续数据进行非虚弱和虚弱/易患患者之间的比较。
从 2016 年 8 月到 2018 年 9 月，有 668 名（年龄 59.5±13.3 岁）患者进行了术前 RAI 评分记录，并接受了计划中的脊柱手术。在手术日期后 90 天（1.9%对 0.2%，P<.05）和 1 年（5.1%对 1.2%，P<.01），虚弱和易患的患者死亡率较高。他们的住院时间也较长（3.9 d±3.6 对 3.1 d±2.8，P<.001），60 天（14.6%对 8.2%，P<.05）和 90 天（15.8%对 9.8%，P<.05）的再入院率也较高。
RAI 测量的术前虚弱与脊柱手术后再入院和 90 天和 1 年死亡率增加相关。RAI 可用于分层脊柱患者并为术前手术决策提供信息。
