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Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery.
Spine J. 2017 04; 17(4):538-544.SJ

Abstract

BACKGROUND CONTEXT

Prior studies have suggested no significant differences in functional status and postoperative complications of elderly versus nonelderly patients undergoing posterior lumbar interbody fusion; however, similar studies have not been comprehensively investigated in the setting of anterior lumbar interbody fusion (ALIF).

PURPOSE

The objective was to quantify the ability of the modified Frailty Index (mFI) to predict postoperative events in patients undergoing ALIF.

STUDY DESIGN

Secondary analysis of prospectively collected data.

PATIENT SAMPLE

Patients undergoing ALIF in the National Surgical Quality Improvement Program (NSQIP) participant files for the period 2010 through 2014.

OUTCOMES MEASURES

Outcome measures included any postoperative complication, return to operating room (OR), and length of stay >5 days.

METHODS

NSQIP participant files from 2010 to 2014 were used to identify patients undergoing ALIF. The mFI used in the present study is an 11-variable assessment that maps 16 NSQIP variables to 11 variables in the Canadian Study of Health and Ageing Frailty Index. Univariate analysis and multivariable logistic regression models were used to compare the relative strength of association between mFI with outcome variables of interest.

RESULTS

In total, 3,920 ALIF cases were identified and grouped according to their mFI score: 0 (n=2,025), 0.09 (n=1,382), 0.18 (n=464), or ≥0.27 (n=49). As the mFI increased from 0 (no frailty-associated variables) to 0.27 (4 of 11) or higher, there was a significant stepwise increase in any complication from 10.8% to 32.7%. After multivariable regression analysis, no significant association was found between higher mFI scores with urinary tract infections and venous thromboembolism. High frailty scores were significant predictors of any complication (mFI of ≥0.27 [reference: 0]; OR 2.4; p=.040) and pulmonary complications (mFI score ≥0.27; OR 7.5; p=.001).

CONCLUSIONS

In summary, high mFI scores were found to be independently associated with any complication and pulmonary complications in patients who underwent ALIF. The use of mFI together with traditional risk factors may help better identify high-surgical risk patients, which may be useful for preoperative and postoperative care optimization.

Authors+Show Affiliations

NeuroSpine Surgery Research Group (NSURG), Suite 7a, Level 7, Prince of Wales Private Hospital, Sydney, Barker St, Randwick, New South Wales 2031, Australia; Faculty of Medicine, University of New South Wales (UNSW), Gate 2, High St, Kensington, New South Wales 2033, Australia.Department of Orthopaedic Surgery at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029, USA.Department of Orthopaedic Surgery at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029, USA.Department of Orthopaedic Surgery at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029, USA.Department of Orthopaedic Surgery at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029, USA.Department of Orthopaedic Surgery at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029, USA.Department of Orthopaedic Surgery at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029, USA.Department of Orthopaedic Surgery at Mount Sinai, 5 East 98th St, Box 1188, New York, NY 10029, USA. Electronic address: samuel.cho@mountsinai.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27989724

Citation

Phan, Kevin, et al. "Frailty Is Associated With Morbidity in Adults Undergoing Elective Anterior Lumbar Interbody Fusion (ALIF) Surgery." The Spine Journal : Official Journal of the North American Spine Society, vol. 17, no. 4, 2017, pp. 538-544.
Phan K, Kim JS, Lee NJ, et al. Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery. Spine J. 2017;17(4):538-544.
Phan, K., Kim, J. S., Lee, N. J., Somani, S., Di Capua, J., Kothari, P., Leven, D., & Cho, S. K. (2017). Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery. The Spine Journal : Official Journal of the North American Spine Society, 17(4), 538-544. https://doi.org/10.1016/j.spinee.2016.10.023
Phan K, et al. Frailty Is Associated With Morbidity in Adults Undergoing Elective Anterior Lumbar Interbody Fusion (ALIF) Surgery. Spine J. 2017;17(4):538-544. PubMed PMID: 27989724.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty is associated with morbidity in adults undergoing elective anterior lumbar interbody fusion (ALIF) surgery. AU - Phan,Kevin, AU - Kim,Jun S, AU - Lee,Nathan J, AU - Somani,Sulaiman, AU - Di Capua,John, AU - Kothari,Parth, AU - Leven,Dante, AU - Cho,Samuel K, Y1 - 2016/10/27/ PY - 2016/03/30/received PY - 2016/08/13/revised PY - 2016/10/25/accepted PY - 2016/12/19/pubmed PY - 2017/8/9/medline PY - 2016/12/20/entrez KW - American College of Surgeons National Surgical Quality Improvement Program KW - Anterior lumbar interbody fusion KW - Frailty index KW - Morbidity KW - Mortality KW - Short term SP - 538 EP - 544 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 17 IS - 4 N2 - BACKGROUND CONTEXT: Prior studies have suggested no significant differences in functional status and postoperative complications of elderly versus nonelderly patients undergoing posterior lumbar interbody fusion; however, similar studies have not been comprehensively investigated in the setting of anterior lumbar interbody fusion (ALIF). PURPOSE: The objective was to quantify the ability of the modified Frailty Index (mFI) to predict postoperative events in patients undergoing ALIF. STUDY DESIGN: Secondary analysis of prospectively collected data. PATIENT SAMPLE: Patients undergoing ALIF in the National Surgical Quality Improvement Program (NSQIP) participant files for the period 2010 through 2014. OUTCOMES MEASURES: Outcome measures included any postoperative complication, return to operating room (OR), and length of stay >5 days. METHODS: NSQIP participant files from 2010 to 2014 were used to identify patients undergoing ALIF. The mFI used in the present study is an 11-variable assessment that maps 16 NSQIP variables to 11 variables in the Canadian Study of Health and Ageing Frailty Index. Univariate analysis and multivariable logistic regression models were used to compare the relative strength of association between mFI with outcome variables of interest. RESULTS: In total, 3,920 ALIF cases were identified and grouped according to their mFI score: 0 (n=2,025), 0.09 (n=1,382), 0.18 (n=464), or ≥0.27 (n=49). As the mFI increased from 0 (no frailty-associated variables) to 0.27 (4 of 11) or higher, there was a significant stepwise increase in any complication from 10.8% to 32.7%. After multivariable regression analysis, no significant association was found between higher mFI scores with urinary tract infections and venous thromboembolism. High frailty scores were significant predictors of any complication (mFI of ≥0.27 [reference: 0]; OR 2.4; p=.040) and pulmonary complications (mFI score ≥0.27; OR 7.5; p=.001). CONCLUSIONS: In summary, high mFI scores were found to be independently associated with any complication and pulmonary complications in patients who underwent ALIF. The use of mFI together with traditional risk factors may help better identify high-surgical risk patients, which may be useful for preoperative and postoperative care optimization. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/27989724/Frailty_is_associated_with_morbidity_in_adults_undergoing_elective_anterior_lumbar_interbody_fusion__ALIF__surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(16)31038-5 DB - PRIME DP - Unbound Medicine ER -