Effect of Frailty on Outcome after Traumatic Spinal Cord Injury

Abstract

Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were identified from our prospectively collected database from 2004 to 2016. We examined effect of patient age, admission Total Motor Score (TMS), and Modified Frailty Index (mFI) on adverse events (AEs), acute length of stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for three age groups: <60, 61-75, and 76+ years), and multi-variable analysis was performed to investigate the impact of age, TMS, and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS ( p = 0.0375), but not of AEs ( p = 0.1428) or in-hospital mortality ( p = 0.1245). In patients <60 years of age, mFI predicted number of AEs, acute LOS, and in-hospital mortality. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years of age, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcomes in those <75 years of age only. The inter-relationship of advanced age and decreased physiological reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger patients with tSCI may be useful for peri-operative optimization, risk stratification, and patient counseling.

Identifying risks factors in thoracolumbar anterior fusion surgery through predictive analytics in a nationally representative inpatient sample

“…Our study confirms these findings, and multivariate analysis revealed increased total hospital costs following surgery in obese patients receiving anterior TL fusion for burst fractures compared to patients with BMIs less than 30. Similarly, patient frailty has been validated as an independent predictor of postoperative complications in several previous studies, and our findings confirm these associations in both patients with scoliosis and burst fractures [45][46][47][48][49][50]. In those patients with scoliosis and burst fractures, frailty was shown to increase the total inpatient LOS non-frail patients.…”

Frailty Is a Better Predictor than Age of Mortality and Perioperative Complications after Surgery for Degenerative Cervical Myelopathy: An Analysis of 41,369 Patients from the NSQIP Database 2010–2018

“…This effect is not linear, as demonstrated by the margins of interaction between age (by decade) and categorical level of frailty (see Figure 1). This effect (for readmission, reoperation, length of stay, and discharge to non-home destination) begins after the age of 60, which is in line with previously reported studies [32,34,35]. The mCCI proved a significant predictor of all adverse events on univariate and multivariable analysis, and the effect size remained similar for both.…”

“…The suggested mechanism for this discrepancy has traditionally been the burden of age-related co-morbidities influencing clinical outcomes and reduction of physiological reserve, which has been manifested as measures of frailty or frailty indices in recent years. This hypothesis has been further substantiated with the correlation of worsening frailty to increased complication rate after spine surgery, and poorer recovery after spinal cord injury [28,34,35]. However, despite DCM being the most common indication for cervical spine surgery in North America, the effect of frailty on the outcomes after DCM surgery has not been investigated [16].…”

The Impact of Older Age on Functional Recovery and Quality of Life Outcomes after Surgical Decompression for Degenerative Cervical Myelopathy: Results from an Ambispective, Propensity-Matched Analysis from the CSM-NA and CSM-I International, Multi-Center Studies

“…ostensibly play more of a role in the determinant of peri-operative risk. This concept of frailty, and its association with the assessment of surgical risk, is emerging as an important tool for surgical decision making and has been a recent focus of interest in pathologies such as spinal cord injury and adult deformity surgery [51,52,53]. However, the impact of frailty on the outcomes from DCM appears to be less well defined.…”