Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
Department of Orthopaedic Surgery, New York Spine Institute, NYU Medical Center-Hospital for Joint Diseases, 301 East 17th St, New York, NY, 10003, USA.
Spine Deform. 2022 Jul;10(4):901-911. doi: 10.1007/s43390-022-00476-x. Epub 2022 Mar 9.
Frailty has been associated with adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity was developed. Components of the ASD-FI utilize patient comorbidity, clinical symptoms, and patient-reported-outcome-measures (PROMS). Our purpose was to investigate components of the Adult Spinal Deformity Frailty Index (ASD-FI) responsive to surgery and drivers of overall frailty.
Operative ASD patients ≥ 18 years, undergoing multilevel fusions, with complete baseline, 6 W, 1Y and 2Y ASD-FI scores. Descriptive analysis assessed demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t tests assessed postoperative changes to ASD-FI components, total score, and radiographic parameters. Linear regression models determined the effect of successful surgery (achieving lowest level SRS-Schwab classification modifiers) on change in ASD-FI total scores.
409 6-week, 696 1-year, and 253 2-year operative ASD patients were included. 6-week and 1-year baseline frailty scores were 0.34, 2 years was 0.38. Following surgery, 6-week frailty was 0.36 (p = 0.033), 1 year was 0.25 (p < 0.001), and 2 years was 0.28 (p < 0.001). Of the ASD-FI variables, 17/40 improved at 6 weeks, 21/40 at 1 year, and 18/40 at 2 years. Successful surgery significantly predicted decreases in 1-year frailty scores (R = 0.27, p < 0.001), SRS-Schwab SVA modifier was the greatest predictor (Adjusted Beta: - 0.29, p < 0.001).
Improvement in sagittal realignment and functional status correlated with improved postoperative frailty. Additional research and deformity sub-group analyses are needed to describe associations between specific functional activities that correlated with frailty improvement as well as evaluation of modifiable and non-modifiable indices.
衰弱与术后不良结局相关。最近，一种新的用于成人脊柱畸形患者术前风险分层的衰弱指数（Frailty Index，FI）被开发出来。ASD-FI 的组成部分利用了患者的合并症、临床症状和患者报告的结果测量（Patient-reported-Outcome-Measures，PROMs）。我们的目的是研究与手术相关的和导致整体衰弱的成人脊柱畸形衰弱指数（Adult Spinal Deformity Frailty Index，ASD-FI）组成部分。
纳入了≥18 岁、接受多节段融合术、基线、6 周、1 年和 2 年 ASD-FI 评分完整的手术 ASD 患者。描述性分析评估了人口统计学、影像学参数和手术细节。Pearson 双变量相关性、独立和配对 t 检验评估了 ASD-FI 成分、总分和影像学参数的术后变化。线性回归模型确定了成功手术（达到最低 SRS-Schwab 分类修饰因子）对 ASD-FI 总分变化的影响。
纳入了 409 例 6 周、696 例 1 年和 253 例 2 年的手术 ASD 患者。6 周和 1 年的基线衰弱评分分别为 0.34 和 0.38。术后 6 周的衰弱评分为 0.36（p=0.033），1 年时为 0.25（p<0.001），2 年时为 0.28（p<0.001）。在 ASD-FI 变量中，40 个中有 17 个在 6 周时改善，40 个中有 21 个在 1 年时改善，40 个中有 18 个在 2 年时改善。成功的手术显著预测了 1 年时衰弱评分的下降（R=0.27，p<0.001），SRS-Schwab SVA 修饰因子是最大的预测因素（调整后的β：-0.29，p<0.001）。
矢状面矫正和功能状态的改善与术后衰弱的改善相关。需要进一步的研究和畸形亚组分析，以描述与衰弱改善相关的特定功能活动之间的关联，以及评估可修改和不可修改的指标。
