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Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion.
Global Spine J. 2017 Sep; 7(6):529-535.GS

Abstract

STUDY DESIGN

Retrospective study of prospectively collected data.

OBJECTIVE

To analyze the modified frailty index (mFI) as a predictor of adverse postoperative events following posterior lumbar fusion.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database including all adult patients undergoing posterior lumbar interbody fusion or transforaminal lumbar interbody fusion between 2005 and 2012. Outcomes measured included mortality, postoperative complications, length of stay, reoperations, and readmissions. The previously described mFI was calculated, and univariate and multivariate logistic regression analysis were used to analyze risk factors associated with morbidity, mortality, and adverse postoperative events. This study was qualified as exempt by the Mount Sinai Hospital Institutional Review Board.

RESULTS

A total of 6094 patients met inclusion criteria. The mean mFI was 0.087(0-0.545). Increasing mFI score was associated with increased complications, reoperations, prolonged length of stay (LOS), and morbidity (P < .05). As the mFI score increased from 0.27 (3/11 variables present) to ≥0.36 (4/11), the rate of any complication increased from 26.8% to 35% (P < .0001), sepsis 2.4% to 5.2% (P < .0001), wound complications 4.4% to 6.5% (P < .0001), unplanned readmissions 4.7% to 20% (P = .02), and urinary tract infection 4.1% to 10.4% (P < .0001). An mFI of ≥0.36 was an independent predictor of any complication (odds ratio [OR]= 2.2, 95% confidence interval [CI] = 1.3-3.7), sepsis (OR = 6.3, 95%, CI = 1.8-21), wound complications (OR = 2.9, 95% CI = 1.1-8.2), prolonged LOS (OR = 2.3, 95% CI = 1.4-3.7), and readmission (OR = 4.3, 95% CI = 1.5-12.7).

CONCLUSION

Patients with higher mFI scores (≥ 4/11 variables) are at a significantly higher risk of major complications, readmissions, and prolonged LOS following lumbar fusion.

Authors+Show Affiliations

Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Prince of Wales Private Hospital, Sydney, New South Wales, Australia. University of New South Wales, Sydney, Sydney, New South Wales, Australia.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28894682

Citation

Leven, Dante M., et al. "Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion." Global Spine Journal, vol. 7, no. 6, 2017, pp. 529-535.
Leven DM, Lee NJ, Kim JS, et al. Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion. Global Spine J. 2017;7(6):529-535.
Leven, D. M., Lee, N. J., Kim, J. S., Kothari, P., Steinberger, J., Guzman, J., Skovrlj, B., Shin, J. I., Phan, K., Caridi, J. M., & Cho, S. K. (2017). Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion. Global Spine Journal, 7(6), 529-535. https://doi.org/10.1177/2192568217700099
Leven DM, et al. Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion. Global Spine J. 2017;7(6):529-535. PubMed PMID: 28894682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frailty Is Predictive of Adverse Postoperative Events in Patients Undergoing Lumbar Fusion. AU - Leven,Dante M, AU - Lee,Nathan J, AU - Kim,Jun S, AU - Kothari,Parth, AU - Steinberger,Jeremy, AU - Guzman,Javier, AU - Skovrlj,Branko, AU - Shin,John I, AU - Phan,Kevin, AU - Caridi,John M, AU - Cho,Samuel K, Y1 - 2017/05/16/ PY - 2017/9/13/entrez PY - 2017/9/13/pubmed PY - 2017/9/13/medline KW - National Surgical Quality Improvement Program KW - frailty index KW - morbidity KW - mortality KW - posterior lumbar fusion SP - 529 EP - 535 JF - Global spine journal JO - Global Spine J VL - 7 IS - 6 N2 - STUDY DESIGN: Retrospective study of prospectively collected data. OBJECTIVE: To analyze the modified frailty index (mFI) as a predictor of adverse postoperative events following posterior lumbar fusion. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database including all adult patients undergoing posterior lumbar interbody fusion or transforaminal lumbar interbody fusion between 2005 and 2012. Outcomes measured included mortality, postoperative complications, length of stay, reoperations, and readmissions. The previously described mFI was calculated, and univariate and multivariate logistic regression analysis were used to analyze risk factors associated with morbidity, mortality, and adverse postoperative events. This study was qualified as exempt by the Mount Sinai Hospital Institutional Review Board. RESULTS: A total of 6094 patients met inclusion criteria. The mean mFI was 0.087(0-0.545). Increasing mFI score was associated with increased complications, reoperations, prolonged length of stay (LOS), and morbidity (P < .05). As the mFI score increased from 0.27 (3/11 variables present) to ≥0.36 (4/11), the rate of any complication increased from 26.8% to 35% (P < .0001), sepsis 2.4% to 5.2% (P < .0001), wound complications 4.4% to 6.5% (P < .0001), unplanned readmissions 4.7% to 20% (P = .02), and urinary tract infection 4.1% to 10.4% (P < .0001). An mFI of ≥0.36 was an independent predictor of any complication (odds ratio [OR]= 2.2, 95% confidence interval [CI] = 1.3-3.7), sepsis (OR = 6.3, 95%, CI = 1.8-21), wound complications (OR = 2.9, 95% CI = 1.1-8.2), prolonged LOS (OR = 2.3, 95% CI = 1.4-3.7), and readmission (OR = 4.3, 95% CI = 1.5-12.7). CONCLUSION: Patients with higher mFI scores (≥ 4/11 variables) are at a significantly higher risk of major complications, readmissions, and prolonged LOS following lumbar fusion. SN - 2192-5682 UR - https://www.unboundmedicine.com/medline/citation/28894682/Frailty_Is_Predictive_of_Adverse_Postoperative_Events_in_Patients_Undergoing_Lumbar_Fusion_ L2 - http://journals.sagepub.com/doi/full/10.1177/2192568217700099?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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