Department of Emergency Medicine, University of New Mexico Hospital, MSC11 6025, 1 University of New Mexico, Albuquerque, NM 87131, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA.
Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA; University of New Mexico School of Medicine, 2501 Frontier Ave NE, Albuquerque, NM 87106, USA.
Spine J. 2023 Dec;23(12):1778-1789. doi: 10.1016/j.spinee.2023.08.008. Epub 2023 Aug 23.
The United States has experienced substantial shifts in its population dynamics due to an aging population and increasing obesity rates. Nonetheless, there is limited data about the interplay between the triad of frailty, aging, and obesity.
To investigate discriminative thresholds and independent associations of the Risk Analysis Index (RAI), Modified Frailty Index-5 (mFI-5), and greater patient age.
An observational retrospective cohort study.
We analyzed 49,754 spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020.
A total of 30-day postoperative mortality.
Using receiver operating characteristic (ROC) and multivariable (odds ratios [OR] and 95% confidence intervals [CI]) analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age in elderly obese patients who underwent spine surgery.
There were 49,754 spine surgery patients, with a median age of 71 years (IQR: 68-75), largely white (82.6%) and male (51.9%). The ROC analysis for 30-day postoperative mortality demonstrated superior discrimination for RAI (C-statistic 0.779, 95%CI 0.54-0.805) compared to mFI-5 (C-statistic 0.623, 95% CI 0.594-0.651) and greater patient age (C-statistic 0.627, 95% CI 0.598-0.656). Multivariable analyses revealed a dose-dependent association and a larger effect magnitude for RAI: frail patients OR: 19.52 (95% CI 18.29-20.82) and very frail patients OR: 65.81 (95% CI 62.32-69.50). A similar trend was observed in the interaction evaluating RAI-age-obesity (p<.001).
Our study highlights a strong association between frailty and 30-day postoperative mortality in elderly obese spine patients, revealing a dose-dependent relationship. The RAI has superior discrimination than the mFI-5 and greater patient age in predicting 30-day postoperative mortality after spine surgery. Using the RAI in preoperative assessments may improve outcomes and help healthcare providers effectively communicate accurate surgical risks and potential benefits, set realistic recovery expectations, and enhances patient satisfaction.
美国的人口动态由于人口老龄化和肥胖率上升而发生了重大变化。尽管如此，关于衰弱、衰老和肥胖三者之间相互作用的资料有限。
研究风险分析指数（RAI）、改良衰弱指数-5（mFI-5）和患者年龄较大的鉴别阈值和独立关联。
观察性回顾性队列研究。
我们分析了 2012 年至 2020 年美国外科医师学会国家手术质量改进计划数据库中的 49754 例脊柱手术患者。
术后 30 天死亡率。
使用接收者操作特征（ROC）和多变量（比值比[OR]和 95%置信区间[CI]）分析，我们比较了 RAI、mFI-5 和年龄较大的患者在接受脊柱手术的老年肥胖患者中的鉴别阈值和独立关联。
共 49754 例脊柱手术患者，中位年龄为 71 岁（IQR：68-75），大多数为白人（82.6%）和男性（51.9%）。术后 30 天死亡率的 ROC 分析显示，RAI 的鉴别能力优于 mFI-5（C 统计量 0.779，95%CI 0.54-0.805）和患者年龄较大（C 统计量 0.627，95%CI 0.598-0.656）。多变量分析显示，RAI 存在剂量依赖性关联和更大的效应幅度：衰弱患者 OR：19.52（95%CI 18.29-20.82）和非常衰弱患者 OR：65.81（95%CI 62.32-69.50）。在评估 RAI-年龄-肥胖的相互作用时，观察到类似的趋势（p<.001）。
我们的研究强调了衰弱与老年肥胖脊柱患者术后 30 天死亡率之间的强烈关联，揭示了一种剂量依赖性关系。RAI 在预测脊柱手术后 30 天术后死亡率方面优于 mFI-5 和患者年龄较大。在术前评估中使用 RAI 可能会改善结果，并帮助医疗保健提供者有效沟通准确的手术风险和潜在收益，设定现实的康复预期，并提高患者满意度。
