Division of Spinal Surgery/Departments of Orthopedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY.
UT Southwestern Medical Center, Dallas, TX.
Spine (Phila Pa 1976). 2021 Nov 15;46(22):1559-1563. doi: 10.1097/BRS.0000000000004148.
Retrospective review of a single-center spine database.
Investigate the intersections of chronological age and physiological age via frailty to determine the influence of surgical invasiveness on patient outcomes.
Frailty is a well-established factor in preoperative risk stratification and prediction of postoperative outcomes. The surgical profile of operative patients with adult spinal deformity (ASD) who present as elderly and not frail (NF) has yet to be investigated. Our aim was to examine the surgical profile and outcomes of patients with ASD who were NF and elderly.
Patients with ASD 18 years or older, four or greater levels fused, with baseline (BL) and follow-up data were included. Patients were categorized by ASD frailty index: NF, Frail (F), severely frail (SF]. An elderly patient was defined as 70 years or older. Patients were grouped into NF/elderly and F/elderly. SRS-Schwab modifiers were assessed at BL and 1 year (0, +, ++). Logistic regression analysis assessed the relationship between increasing invasiveness, no reoperations, or major complications, and improvement in SRS-Schwab modifiers [Good Outcome]. Decision tree analysis assessed thresholds for an invasiveness risk/benefit cutoff point.
A total of 598 patients with ASD included (55.3 yr, 59.7% F, 28.3 kg/m2). 29.8% of patients were older than 70 years. At BL, 51.3% of patients were NF, 37.5% F, and 11.2% SF. Sixty-sis (11%) patients were NF and elderly. About 24.2% of NF-elderly patients improved in SRS-Schwab by 1 year and had no reoperation or complication postoperatively. Binary regression analysis found a relationship between worsening SRS-Schwab, postop complication, and reoperation with invasiveness score (odds ratio: 1.056 [1.01-1.102], P = 0.011). Risk/benefit cut-off was 10 (P = 0.004). Patients below this threshold were 7.9 (2.2-28.4) times more likely to have a Good Outcome. 156 patients were elderly and F/SF with 16.7% having good outcome, with a risk/benefit cut-off point of less than 8 (4.4 [2.2-9.0], P < 0.001).
Frailty status impacted the balance of surgical invasiveness relative to operative risk in an inverse manner, whereas the opposite was seen amongst elderly patients with a frailty status less than their chronologic age. Surgeons should perhaps consider incorporation of frailty status over age status when determining realignment plans in patients of advanced age.Level of Evidence: 3.
单中心脊柱数据库的回顾性研究。
通过虚弱程度来研究年龄和生理年龄的交点，以确定手术侵袭性对患者结局的影响。
虚弱是术前风险分层和预测术后结果的一个既定因素。接受手术治疗的成人脊柱畸形（ASD）患者的手术特征，这些患者表现为年龄较大但不虚弱（NF），尚未得到研究。我们的目的是研究 NF 和年龄较大的 ASD 患者的手术特征和结局。
纳入年龄在 18 岁或以上、融合 4 个或更多节段、具有基线（BL）和随访数据的 ASD 患者。患者根据 ASD 虚弱指数进行分类：NF、虚弱（F）、严重虚弱（SF）。70 岁或以上的患者被定义为老年患者。患者分为 NF/老年组和 F/老年组。BL 和 1 年时评估 SRS-Schwab 修正因子（0、+、++）。逻辑回归分析评估了侵袭性增加、无再次手术或主要并发症与 SRS-Schwab 修正因子改善（良好结局）之间的关系。决策树分析评估了侵袭性风险/获益截断点的阈值。
共纳入 598 例 ASD 患者（55.3 岁，59.7%为 F，28.3kg/m2）。29.8%的患者年龄大于 70 岁。BL 时，51.3%的患者为 NF，37.5%为 F，11.2%为 SF。66（11%）例患者为 NF 和老年患者。约 24.2%的 NF-老年患者在 SRS-Schwab 方面改善了 1 年，术后无再次手术或并发症。二元回归分析发现，SRS-Schwab 恶化、术后并发症和再次手术与侵袭性评分之间存在关系（比值比：1.056[1.01-1.102]，P=0.011）。风险/获益截断值为 10（P=0.004）。低于该阈值的患者发生良好结局的可能性高 7.9 倍（2.2-28.4）。156 例老年患者为 F/SF，其中 16.7%有良好结局，风险/获益截断值低于 8（4.4[2.2-9.0]，P<0.001）。
虚弱状况以与手术风险相反的方式影响手术侵袭性的平衡，而在虚弱状况低于其年龄的老年患者中则相反。当确定高龄患者的重新定位计划时，外科医生可能应该考虑将虚弱状况纳入年龄状况。
3。
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