Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery/NYU Langone Medical Center, New York Spine Institute, New York, NY.
Department of Neurosurgery, University of California San Francisco, CA.
Spine (Phila Pa 1976). 2024 Sep 15;49(18):1269-1274. doi: 10.1097/BRS.0000000000004981. Epub 2024 Apr 9.
Retrospective single-center study.
To assess the influence of frailty on optimal outcome following ASD corrective surgery.
Frailty is a determining factor in outcomes after ASD surgery and may exert a ceiling effect on the best possible outcome.
ASD patients with frailty measures, baseline, and 2-year ODI included. Frailty was classified as Not Frail (NF), Frail (F) and Severely Frail (SF) based on the modified Frailty Index, then stratified into quartiles based on two-year ODI improvement (most improved designated "Highest"). Logistic regression analyzed relationships between frailty and ODI score and improvement, maintenance, or deterioration. A Kaplan-Meier survival curve was used to analyze differences in time to complication or reoperation.
A total of 393 ASD patients were isolated (55.2% NF, 31.0% F, and 13.7% SF), then classified as 12.5% NF-Highest, 17.8% F-Highest, and 3.1% SF-Highest. The SF group had the highest rate of deterioration (16.7%, P =0.025) in the second postoperative year, but the groups were similar in improvement (NF: 10.1%, F: 11.5%, SF: 9.3%, P =0.886). Improvement of SF patients was greatest at six months (ΔODI of -22.6±18.0, P <0.001), but NF and F patients reached maximal ODI at 2 years (ΔODI of -15.7±17.9 and -20.5±18.4, respectively). SF patients initially showed the greatest improvement in ODI (NF: -4.8±19.0, F: -12.4±19.3, SF: -22.6±18.0 at six months, P <0.001). A Kaplan-Meier survival curve showed a trend of less time to major complication or reoperation by 2 years with increasing frailty (NF: 7.5±0.381 yr, F: 6.7±0.511 yr, SF: 5.8±0.757 yr; P =0.113).
Increasing frailty had a negative effect on maximal improvement, where severely frail patients exhibited a parabolic effect with greater initial improvement due to higher baseline disability, but reached a ceiling effect with less overall maximal improvement. Severe frailty may exert a ceiling effect on improvement and impair maintenance of improvement following surgery.
Level III.
回顾性单中心研究。
评估衰弱对 ASD 矫正手术后最佳结局的影响。
衰弱是 ASD 手术后结局的决定因素，可能对最佳结局产生上限效应。
纳入衰弱测量、基线和 2 年 ODI 的 ASD 患者。根据改良衰弱指数将衰弱分为非衰弱（NF）、衰弱（F）和严重衰弱（SF），然后根据 2 年 ODI 改善情况分为四分位数（改善最明显者指定为“最高”）。Logistic 回归分析衰弱与 ODI 评分和改善、维持或恶化之间的关系。Kaplan-Meier 生存曲线用于分析并发症或再次手术时间的差异。
共纳入 393 例 ASD 患者（55.2% NF、31.0% F 和 13.7% SF），然后分为 12.5% NF-最高、17.8% F-最高和 3.1% SF-最高。SF 组在术后第二年恶化率最高（16.7%，P=0.025），但各组改善情况相似（NF：10.1%，F：11.5%，SF：9.3%，P=0.886）。SF 患者在术后 6 个月时改善最大（ODI 变化值为-22.6±18.0，P＜0.001），但 NF 和 F 患者在 2 年时达到最大 ODI（ODI 变化值分别为-15.7±17.9 和-20.5±18.4）。SF 患者最初 ODI 改善最大（NF：-4.8±19.0，F：-12.4±19.3，SF：-22.6±18.0，均在 6 个月时，P＜0.001）。Kaplan-Meier 生存曲线显示，随着衰弱程度的增加，2 年内发生主要并发症或再次手术的时间呈减少趋势（NF：7.5±0.381 年，F：6.7±0.511 年，SF：5.8±0.757 年；P=0.113）。
衰弱程度的增加对最大改善有负面影响，严重衰弱患者由于基线残疾程度较高，初始改善较大，但由于整体最大改善程度较低，达到上限效应。严重衰弱可能对手术改善和维持产生上限效应。
III 级。
