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The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation.
World Neurosurg. 2018 Aug; 116:e225-e231.WN

Abstract

BACKGROUND

Vertebral compression fractures are the most common spine injury seen in elderly patients. Vertebral augmentation is considered a safe and effective treatment. The ability to predict outcomes based on comorbidities is lacking. The modified frailty index has been used to predict complications after orthopedic and surgical procedures. We hypothesized that despite a low rate of adverse outcomes, postoperative complications after kyphoplasty would be greater in patients who are frail.

METHODS

The National Surgical Quality Improvement Program database was queried for patients who underwent kyphoplasty between 2006 and 2015. Complication data including 30-day complications, life-threatening complications, reoperation and readmission rate, and length of stay data was recorded, and 5-item modified frailty index (5i-mFI) scores were calculated. Univariate and multivariate logistic regression analyses were then conducted to analyze frailty as a predictor of postoperative complications after kyphoplasty.

RESULTS

In total, 2465 patients were identified (mean age = 73.98). As 5i-mFI increased from 0 to ≥2, the rate of overall complications increased nearly 3-fold from 3.7% to 10.4% (P < 0.001) and the rate of life-threatening complications increased from 0.8% to 2.4% (P = 0.042). In addition, 30-day readmission increased from 8.9% to 12.9% (P = 0.005), adverse hospital discharge increased from 7.6% to 25.6% (P < 0.001), and length of stay increased from 1.66 days to 3.75 days (P < 0.001). Frailty was associated with increased total complications, Clavien-Dindo IV complications, length of stay, and 30-day readmission rates.

CONCLUSIONS

The 5i-mFI is a straightforward assessment tool that correlates with outcomes after kyphoplasty. It can be used to help clinicians predict adverse events and facilitate informed discussions with their patients.

Authors+Show Affiliations

Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA. Electronic address: Dsegal2@emory.edu.Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA.Department of Orthopedics, Emory University School of Medicine, Atlanta, Georgia, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29729455

Citation

Segal, Dale N., et al. "The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation." World Neurosurgery, vol. 116, 2018, pp. e225-e231.
Segal DN, Wilson JM, Staley C, et al. The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation. World Neurosurg. 2018;116:e225-e231.
Segal, D. N., Wilson, J. M., Staley, C., & Michael, K. W. (2018). The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation. World Neurosurgery, 116, e225-e231. https://doi.org/10.1016/j.wneu.2018.04.172
Segal DN, et al. The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation. World Neurosurg. 2018;116:e225-e231. PubMed PMID: 29729455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The 5-Item Modified Frailty Index Is Predictive of 30-Day Postoperative Complications in Patients Undergoing Kyphoplasty Vertebral Augmentation. AU - Segal,Dale N, AU - Wilson,Jacob M, AU - Staley,Christopher, AU - Michael,Keith W, Y1 - 2018/05/03/ PY - 2018/03/19/received PY - 2018/04/22/revised PY - 2018/04/23/accepted PY - 2018/5/8/pubmed PY - 2018/10/13/medline PY - 2018/5/6/entrez KW - 5-item modified frailty index KW - Complications KW - Kyphoplasty KW - Modified frailty index KW - NSQIP SP - e225 EP - e231 JF - World neurosurgery JO - World Neurosurg VL - 116 N2 - BACKGROUND: Vertebral compression fractures are the most common spine injury seen in elderly patients. Vertebral augmentation is considered a safe and effective treatment. The ability to predict outcomes based on comorbidities is lacking. The modified frailty index has been used to predict complications after orthopedic and surgical procedures. We hypothesized that despite a low rate of adverse outcomes, postoperative complications after kyphoplasty would be greater in patients who are frail. METHODS: The National Surgical Quality Improvement Program database was queried for patients who underwent kyphoplasty between 2006 and 2015. Complication data including 30-day complications, life-threatening complications, reoperation and readmission rate, and length of stay data was recorded, and 5-item modified frailty index (5i-mFI) scores were calculated. Univariate and multivariate logistic regression analyses were then conducted to analyze frailty as a predictor of postoperative complications after kyphoplasty. RESULTS: In total, 2465 patients were identified (mean age = 73.98). As 5i-mFI increased from 0 to ≥2, the rate of overall complications increased nearly 3-fold from 3.7% to 10.4% (P < 0.001) and the rate of life-threatening complications increased from 0.8% to 2.4% (P = 0.042). In addition, 30-day readmission increased from 8.9% to 12.9% (P = 0.005), adverse hospital discharge increased from 7.6% to 25.6% (P < 0.001), and length of stay increased from 1.66 days to 3.75 days (P < 0.001). Frailty was associated with increased total complications, Clavien-Dindo IV complications, length of stay, and 30-day readmission rates. CONCLUSIONS: The 5i-mFI is a straightforward assessment tool that correlates with outcomes after kyphoplasty. It can be used to help clinicians predict adverse events and facilitate informed discussions with their patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29729455/The_5_Item_Modified_Frailty_Index_Is_Predictive_of_30_Day_Postoperative_Complications_in_Patients_Undergoing_Kyphoplasty_Vertebral_Augmentation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)30892-1 DB - PRIME DP - Unbound Medicine ER -