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Frailty Index as a Predictor of Adverse Postoperative Outcomes in Patients Undergoing Cervical Spinal Fusion.
Spine (Phila Pa 1976). 2017 Mar; 42(5):304-310.S

Abstract

STUDY DESIGN

Retrospective study of prospectively collected data.

OBJECTIVE

To investigate the applicability of the modified frailty index (mFI) as a predictor of adverse postoperative events in patients undergoing anterior cervical discectomy and fusion (ACDF) or posterior cervical fusion (PCF).

SUMMARY OF BACKGROUND DATA

Prior studies have investigated the mFI and shown it as an independent predictor of adverse postoperative outcomes across multiple surgical specialties. However, this topic has not still been studied in patients undergoing cervical fusion or in spinal surgery.

METHODS

The National Surgical Quality Improvement Program is a multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent elective ACDF and PCF between 2005 and 2012. The mFI was calculated for each patient. Univariate analysis and multivariate logistic regression were used to analyze the mFI as a predictor for postoperative complications.

RESULTS

For ACDF group, Clavien-Dindo grade IV complications rate increased from 0.8% to 9.0% as mFI increased from 0 to ≥0.27, and mFI = 0.27 was found to be an independent predictor of Clavien-Dindo grade IV complications (odds ratio, OR, = 4.67, 95% confidence interval, CI, = 2.27-9.62, P < 0.001). For PCF groups, Clavien-Dindo grade IV complications rate increased from 0.7% to 20.0% as mFI increased from 0 to ≥0.36, and mFI ≥ 0.36 was identified as an independent predictor of Clavien-Dindo grade IV complications (OR = 41.26, 95% CI = 6.62-257.15, P < 0.001).

CONCLUSION

The mFI was shown to be an independent predictor of Clavien-Dindo grade IV complications in patients undergoing ACDF or PCF. The mFI itself may be used to stratify risks in patients undergoing cervical fusion, or, the mFI scheme could be used as a platform upon which more efficient risk stratification could be done with addition of other variables.

LEVEL OF EVIDENCE

4.

Authors+Show Affiliations

*Leni and Peter W. May Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY †NeuroSpine Surgery Research Group, University of New South Wales, Sydney, Australia ‡Faculty of Medicine, University of New South Wales, Sydney, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27379416

Citation

Shin, John I., et al. "Frailty Index as a Predictor of Adverse Postoperative Outcomes in Patients Undergoing Cervical Spinal Fusion." Spine, vol. 42, no. 5, 2017, pp. 304-310.
Shin JI, Kothari P, Phan K, et al. Frailty Index as a Predictor of Adverse Postoperative Outcomes in Patients Undergoing Cervical Spinal Fusion. Spine. 2017;42(5):304-310.
Shin, J. I., Kothari, P., Phan, K., Kim, J. S., Leven, D., Lee, N. J., & Cho, S. K. (2017). Frailty Index as a Predictor of Adverse Postoperative Outcomes in Patients Undergoing Cervical Spinal Fusion. Spine, 42(5), 304-310. https://doi.org/10.1097/BRS.0000000000001755
Shin JI, et al. Frailty Index as a Predictor of Adverse Postoperative Outcomes in Patients Undergoing Cervical Spinal Fusion. Spine. 2017;42(5):304-310. PubMed PMID: 27379416.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty Index as a Predictor of Adverse Postoperative Outcomes in Patients Undergoing Cervical Spinal Fusion. AU - Shin,John I, AU - Kothari,Parth, AU - Phan,Kevin, AU - Kim,Jun S, AU - Leven,Dante, AU - Lee,Nathan J, AU - Cho,Samuel K, PY - 2016/7/6/pubmed PY - 2017/9/28/medline PY - 2016/7/6/entrez SP - 304 EP - 310 JF - Spine JO - Spine VL - 42 IS - 5 N2 - STUDY DESIGN: Retrospective study of prospectively collected data. OBJECTIVE: To investigate the applicability of the modified frailty index (mFI) as a predictor of adverse postoperative events in patients undergoing anterior cervical discectomy and fusion (ACDF) or posterior cervical fusion (PCF). SUMMARY OF BACKGROUND DATA: Prior studies have investigated the mFI and shown it as an independent predictor of adverse postoperative outcomes across multiple surgical specialties. However, this topic has not still been studied in patients undergoing cervical fusion or in spinal surgery. METHODS: The National Surgical Quality Improvement Program is a multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent elective ACDF and PCF between 2005 and 2012. The mFI was calculated for each patient. Univariate analysis and multivariate logistic regression were used to analyze the mFI as a predictor for postoperative complications. RESULTS: For ACDF group, Clavien-Dindo grade IV complications rate increased from 0.8% to 9.0% as mFI increased from 0 to ≥0.27, and mFI = 0.27 was found to be an independent predictor of Clavien-Dindo grade IV complications (odds ratio, OR, = 4.67, 95% confidence interval, CI, = 2.27-9.62, P < 0.001). For PCF groups, Clavien-Dindo grade IV complications rate increased from 0.7% to 20.0% as mFI increased from 0 to ≥0.36, and mFI ≥ 0.36 was identified as an independent predictor of Clavien-Dindo grade IV complications (OR = 41.26, 95% CI = 6.62-257.15, P < 0.001). CONCLUSION: The mFI was shown to be an independent predictor of Clavien-Dindo grade IV complications in patients undergoing ACDF or PCF. The mFI itself may be used to stratify risks in patients undergoing cervical fusion, or, the mFI scheme could be used as a platform upon which more efficient risk stratification could be done with addition of other variables. LEVEL OF EVIDENCE: 4. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/27379416/Frailty_Index_as_a_Predictor_of_Adverse_Postoperative_Outcomes_in_Patients_Undergoing_Cervical_Spinal_Fusion_ L2 - http://dx.doi.org/10.1097/BRS.0000000000001755 DB - PRIME DP - Unbound Medicine ER -