Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2021 Aug 15;46(16):1087-1096. doi: 10.1097/BRS.0000000000003977.
Retrospective review of a prospectively enrolled multicenter Adult Spinal Deformity (ASD) database.
Investigate invasiveness and outcomes of ASD surgery by frailty state.
The ASD Invasiveness Index incorporates deformity-specific components to assess correction magnitude. Intersections of invasiveness, surgical outcomes, and frailty state are understudied.
ASD patients with baseline and 3-year (3Y) data were included. Logistic regression analyzed the relationship between increasing invasiveness and major complications or reoperations and meeting minimal clinically important differences (MCID) for health-related quality-of-life measures at 3Y. Decision tree analysis assessed invasiveness risk-benefit cutoff points, above which experiencing complications or reoperations and not reaching MCID were higher. Significance was set to P < 0.05.
Overall, 195 of 322 patients were included. Baseline demographics: age 59.9 ± 14.4, 75% female, BMI 27.8 ± 6.2, mean Charlson Comorbidity Index: 1.7 ± 1.7. Surgical information: 61% osteotomy, 52% decompression, 11.0 ± 4.1 levels fused. There were 98 not frail (NF), 65 frail (F), and 30 severely frail (SF) patients. Relationships were found between increasing invasiveness and experiencing a major complication or reoperation for the entire cohort and by frailty group (all P < 0.05). Defining a favorable outcome as no major complications or reoperation and meeting MCID in any health-related quality of life at 3Y established an invasiveness cutoff of 63.9. Patients below this threshold were 1.8[1.38-2.35] (P < 0.001) times more likely to achieve favorable outcome. For NF patients, the cutoff was 79.3 (2.11[1.39-3.20] (P < 0.001), 111 for F (2.62 [1.70-4.06] (P < 0.001), and 53.3 for SF (2.35[0.78-7.13] (P = 0.13).
Increasing invasiveness is associated with increased odds of major complications and reoperations. Risk-benefit cutoffs for successful outcomes were 79.3 for NF, 111 for F, and 53.3 for SF patients. Above these, increasing invasiveness has increasing risk of major complications or reoperations and not meeting MCID at 3Y.Level of Evidence: 3.
前瞻性纳入的多中心成人脊柱畸形（ASD）数据库的回顾性研究。
根据虚弱状态研究 ASD 手术的侵袭性和结果。
ASD 侵袭性指数纳入了特定于畸形的成分，以评估矫正幅度。侵袭性、手术结果和虚弱状态的交叉点研究较少。
纳入基线和 3 年（3Y）数据的 ASD 患者。逻辑回归分析了侵袭性增加与主要并发症或再次手术之间的关系，以及在 3Y 时达到健康相关生活质量测量的最小临床重要差异（MCID）的关系。决策树分析评估了侵袭性风险-效益的临界值，超过这些临界值，并发症或再次手术的发生率和未达到 MCID 的发生率更高。设定显著性水平为 P<0.05。
共有 322 例患者中的 195 例被纳入研究。基线人口统计学数据：年龄 59.9±14.4 岁，75%为女性，BMI 27.8±6.2，平均 Charlson 合并症指数为 1.7±1.7。手术信息：61%行截骨术，52%行减压术，融合 11.0±4.1 个节段。其中 98 例非虚弱（NF），65 例虚弱（F），30 例严重虚弱（SF）患者。整个队列和虚弱组之间都发现了侵袭性增加与发生主要并发症或再次手术之间的关系（均 P<0.05）。将无主要并发症或再次手术且在任何健康相关生活质量方面达到 MCID 定义为良好结果，确定了侵袭性的临界值为 63.9。低于此阈值的患者发生不良结果的可能性是 1.8[1.38-2.35]（P<0.001）倍。对于 NF 患者，临界值为 79.3（2.11[1.39-3.20]（P<0.001），F 患者为 111（2.62[1.70-4.06]（P<0.001），SF 患者为 53.3（2.35[0.78-7.13]（P=0.13）。
侵袭性增加与主要并发症和再次手术的发生几率增加有关。NF 患者的成功治疗的风险效益临界值为 79.3，F 患者为 111，SF 患者为 53.3。超过这些临界值，侵袭性增加会增加发生主要并发症或再次手术以及在 3Y 时未达到 MCID 的风险。
3。
