Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Clin Neurol Neurosurg. 2022 Nov;222:107426. doi: 10.1016/j.clineuro.2022.107426. Epub 2022 Aug 30.
Frailty is a measure of physiologic vulnerability conceptualized as the accumulation of deficits with aging, and may be useful for predicting risk of adverse events following posterior spinal fusion. Our objective was to investigate the utility of the Canadian Study on Health and Aging (CHSA) Modified Frailty Index (mFI) in patients undergoing posterior spinal fusion (PSF) as a predictor of several surgical quality metrics including readmission, reoperation, and surgical site infection.
We examined 3965 consecutive PSF patients treated at our institution between 2000 and 2015, and collected demographic, clinical, and frailty and comorbid disease burden measures using the mFI and Charlson Comorbidity Index (CCI). We examined trends and changes in these clinical and demographic characteristics over the course of the study period. We performed multivariable regression to identify independent predictors of readmission, reoperation, and surgical site infection.
Over the course of the study period, the mean patient age increased linearly year-over-year (ß=0.60 [0.48, 0.72], p < 0.0001, R=0.94), while the SSI rate decreased linearly (ß=-0.14 [-0.27, -0.02], p = 0.0249, R=0.56), and frailty scores did not change significantly (p = 0.8124, R=0.065). Among all patients undergoing PSF, postoperative wound infection was independently associated with number of levels fused (OR=1.104 p < 0.001), frailty as measured by mFI (OR=1.150 p = 0.006), and BMI (OR=1.041 p = 0.008). Frailty was also independently associated with postoperative ICU admission (OR=1.1080 p = 0.005), 30-day readmission (OR=1.181 p < 0.001), and 30-day reoperation (OR=1.128 p < 0.001). Among all patients, rate of postoperative wound infection increased with increasing frailty (p = 0.0002) and increasing comorbid disease burden (chi-square p = 0.0012).
The mFI predicts adverse events among patients undergoing PSF, including readmission, reoperation, and surgical site infection. When controlling for frailty, age was not an independent predictor of adverse events.
衰弱是一种生理脆弱性的衡量标准，被认为是随着年龄的增长而积累的缺陷，可能有助于预测后路脊柱融合术后不良事件的风险。我们的目的是研究加拿大健康与老龄化研究（CHSA）改良衰弱指数（mFI）在后路脊柱融合术（PSF）患者中的应用，作为预测多种手术质量指标的指标，包括再入院、再次手术和手术部位感染。
我们检查了 2000 年至 2015 年间在我们机构接受治疗的 3965 例连续 PSF 患者，并使用 mFI 和 Charlson 合并症指数（CCI）收集了人口统计学、临床和衰弱以及合并症疾病负担的测量值。我们检查了研究期间这些临床和人口统计学特征的趋势和变化。我们进行了多变量回归分析，以确定再入院、再次手术和手术部位感染的独立预测因素。
在研究期间，患者的平均年龄逐年线性增加（β=0.60[0.48,0.72]，p<0.0001，R=0.94），而手术部位感染率线性下降（β=-0.14[-0.27,-0.02]，p=0.0249，R=0.56），衰弱评分无显著变化（p=0.8124，R=0.065）。在所有接受 PSF 的患者中，术后伤口感染与融合节段数（OR=1.104，p<0.001）、mFI 测量的衰弱程度（OR=1.150，p=0.006）和 BMI（OR=1.041，p=0.008）独立相关。衰弱与术后 ICU 入院（OR=1.1080，p=0.005）、30 天再入院（OR=1.181，p<0.001）和 30 天再次手术（OR=1.128，p<0.001）也独立相关。在所有患者中，术后伤口感染的发生率随着衰弱程度的增加而增加（p=0.0002）和合并症疾病负担的增加（卡方 p=0.0012）。
mFI 预测接受 PSF 治疗的患者的不良事件，包括再入院、再次手术和手术部位感染。在控制衰弱的情况下，年龄不是不良事件的独立预测因素。
