School of Medicine, New York Medical College, Valhalla, NY, 10595, USA.
Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA.
Spine Deform. 2023 Sep;11(5):1189-1197. doi: 10.1007/s43390-023-00712-y. Epub 2023 Jun 8.
To evaluate the utility of 5-Item Modified Frailty Index (mFI-5) as compared to chronological age in predicting outcomes of spinal osteotomy in Adult Spinal Deformity (ASD) patients.
Using Current Procedural and Terminology (CPT) codes, the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) database was queried for adult patients undergoing spinal osteotomy from 2015 to 2019. Multivariate regression analysis was performed to evaluate the effect of baseline frailty status, measured by mFI-5 score, and chronological age on postoperative outcomes. Receiver-operating characteristic (ROC) curve analysis was performed to analyze the discriminative performance of age versus mFI-5.
A total of 1,789 spinal osteotomy patients (median age 62 years) were included in the analysis. Among the patients assessed, 38.5% (n = 689) were pre-frail, 14.6% frail (n = 262), and 2.2% (n = 39) severely frail using the mFI-5. Based on the multivariate analysis, increasing frailty tier was associated with worsening outcomes, and higher odds ratios (OR) for poor outcomes were found for increasing frailty tiers as compared to age. Severe frailty was associated with the worst outcomes, e.g., unplanned readmission (OR 9.618, [95% CI 4.054-22.818], p < 0.001) and major complications (OR 5.172, [95% CI 2.271-11.783], p < 0.001). In the ROC curve analysis, mFI-5 score (AUC 0.838) demonstrated superior discriminative performance than age (AUC 0.601) for mortality.
The mFI5 frailty score was found to be a better predictor than age of worse postoperative outcomes in ASD patients. Incorporating frailty in preoperative risk stratification is recommended in ASD surgery.
评估 5 项改良衰弱指数（mFI-5）与年龄相比在预测成人脊柱畸形（ASD）患者脊柱截骨术后结局中的作用。
使用当前程序和术语（CPT）代码，从 2015 年至 2019 年，在美国外科医师学院国家手术质量改进计划（ACS-NSQIP）数据库中查询接受脊柱截骨术的成年患者。进行多变量回归分析，以评估基线衰弱状态（通过 mFI-5 评分衡量）和年龄对术后结局的影响。进行受试者工作特征（ROC）曲线分析，以分析年龄与 mFI-5 的区分性能。
共纳入 1789 例脊柱截骨术患者（中位年龄 62 岁）进行分析。在评估的患者中，38.5%（n=689）为衰弱前期，14.6%为衰弱（n=262），2.2%（n=39）为严重衰弱。基于多变量分析，衰弱程度增加与结局恶化相关，与年龄相比，随着衰弱程度增加，不良结局的优势比（OR）越高。严重衰弱与最差结局相关，例如，计划外再入院（OR 9.618，[95%CI 4.054-22.818]，p<0.001）和主要并发症（OR 5.172，[95%CI 2.271-11.783]，p<0.001）。ROC 曲线分析显示，mFI-5 评分（AUC 0.838）对死亡率的预测能力优于年龄（AUC 0.601）。
与年龄相比，mFI5 衰弱评分是预测 ASD 患者术后不良结局的更好指标。建议在 ASD 手术中纳入术前衰弱分层。
