Mohammad Ismail Ahmad, Hildebrand Frank, Forssten Maximilian Peter, Ribeiro Marcelo A F, Chang Parker, Cao Yang, Sarani Babak, Mohseni Shahin
School of Medical Sciences, Orebro University, Orebro, Sweden.
Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.
Trauma Surg Acute Care Open. 2024 Jul 11;9(1):e001265. doi: 10.1136/tsaco-2023-001265. eCollection 2024.
With an aging global population, the prevalence of frailty in patients with traumatic spinal injury (TSI) is steadily increasing. The aim of the current study is to evaluate the utility of the Orthopedic Frailty Score (OFS) in assessing the risk of adverse outcomes in patients with isolated TSI requiring surgery, with the hypothesis that frailer patients suffer from a disproportionately increased risk of these outcomes.
The Trauma Quality Improvement Program database was queried for all adult patients (18 years or older) who suffered an isolated TSI due to blunt force trauma, between 2013 and 2019, and underwent spine surgery. Patients were categorized as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The association between the OFS and in-hospital mortality, complications, and failure to rescue (FTR) was determined using Poisson regression models, adjusted for potential confounding.
A total of 43 768 patients were included in the current investigation. After adjusting for confounding, frailty was associated with a more than doubling in the risk of in-hospital mortality (adjusted incidence rate ratio (IRR) (95% CI): 2.53 (2.04 to 3.12), p<0.001), a 25% higher overall risk of complications (adjusted IRR (95% CI): 1.25 (1.02 to 1.54), p=0.032), a doubling in the risk of FTR (adjusted IRR (95% CI): 2.00 (1.39 to 2.90), p<0.001), and a 10% increase in the risk of intensive care unit admission (adjusted IRR (95% CI): 1.10 (1.04 to 1.15), p=0.004), compared with non-frail patients.
The findings indicate that the OFS could be an effective method for identifying frail patients with TSIs who are at a disproportionate risk of adverse events.
Level III.
随着全球人口老龄化，创伤性脊髓损伤（TSI）患者中衰弱的患病率正在稳步上升。本研究的目的是评估骨科衰弱评分（OFS）在评估需要手术的单纯TSI患者不良结局风险中的效用，假设衰弱程度较高的患者出现这些结局的风险会不成比例地增加。
查询创伤质量改进计划数据库，以获取2013年至2019年间因钝性暴力创伤而遭受单纯TSI并接受脊柱手术的所有成年患者（18岁及以上）。患者被分类为非衰弱（OFS 0）、衰弱前期（OFS 1）或衰弱（OFS≥2）。使用泊松回归模型确定OFS与住院死亡率、并发症和未能挽救（FTR）之间的关联，并对潜在混杂因素进行调整。
本研究共纳入43768例患者。在调整混杂因素后，衰弱与住院死亡率风险增加一倍以上相关（调整后的发病率比（IRR）（95%CI）：2.53（2.04至3.12），p<0.001），总体并发症风险高25%（调整后的IRR（95%CI）：1.25（1.02至1.54），p=0.032），FTR风险增加一倍（调整后的IRR（95%CI）：2.00（1.39至2.90），p<0.001），与非衰弱患者相比，重症监护病房入住风险增加10%（调整后的IRR（95%CI）：1.10（1.04至1.15），p=0.004）。
研究结果表明，OFS可能是识别TSI衰弱患者的有效方法，这些患者发生不良事件的风险不成比例。
三级。
