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Eur Spine J. 2018 Sep;27(9):2331-2338. doi: 10.1007/s00586-018-5575-3. Epub 2018 Mar 30.

External validation of the adult spinal deformity (ASD) frailty index (ASD-FI).

Author information

1
Department of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA, USA.
2
Spine Research Unit, Hospital Vall d'Hebron Institute of Research, Barcelona, Spain.
3
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA. bneuman7@jhmi.edu.
4
Department of Neurosurgery, The Johns Hopkins University, Baltimore, MD, USA.
5
Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA.
6
Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
7
Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey.
8
Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey.
9
Department of Orthopedics and Neurosurgery, Schulthess Klinik, Zurich, Switzerland.
10
Department of Spine Surgery, Bordeaux University Hospital, Bordeaux, France.
11
Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain.
12
Norton Leatherman Spine Center, University of Louisville, Louisville, KY, USA.
13
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
14
Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA.
15
University of California San Diego School of Medicine, San Diego, CA, USA.
16
Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.

Abstract

PURPOSE:

To assess the ability of the recently developed adult spinal deformity frailty index (ASD-FI) to predict odds of perioperative complications, odds of reoperation, and length of hospital stay after adult spinal deformity (ASD) surgery using a database other than the one used to create the index.

METHODS:

We used the ASD-FI to calculate frailty scores for 266 ASD patients who had minimum postoperative follow-up of 2 years in the European Spine Study Group (ESSG) database. Patients were enrolled from 2012 through 2013. Using ASD-FI scores, we categorized patients as not frail (NF) (< 0.3 points), frail (0.3-0.5 points), or severely frail (SF) (> 0.5 points). Multivariable logistic regression, adjusted for preoperative and surgical factors such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and odds of major complications, odds of reoperation, and length of hospital stay.

RESULTS:

We categorized 135 patients (51%) as NF, 90 patients (34%) as frail, and 41 patients (15%) as SF. Overall mean ASD-FI score was 0.29 (range 0-0.8). The adjusted odds of experiencing a major intraoperative or postoperative complication (OR 4.5, 95% CI 2.0-10) or having a reoperation (OR 3.9, 95% CI 1.7-8.9) were higher for SF patients compared with NF patients. Mean hospital stay was 2.1 times longer (95% CI 1.8-2.4) for SF patients compared with NF patients.

CONCLUSIONS:

Greater patient frailty, as measured by the ASD-FI, is associated with longer hospital stays and greater odds of major complications and reoperation. These slides can be retrieved under Electronic Supplementary Material.

KEYWORDS:

Adult spinal deformity; Comorbidities; Complications; Frailty index; Functional status; Preoperative risk stratification

PMID:
29603013
DOI:
10.1007/s00586-018-5575-3
[Indexed for MEDLINE]

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