<p>Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery</p>

Abstract

Background and Aim: Frailty is an independent predictor of mortality and adverse events (AEs) in patients undergoing surgery. This study aimed to quantify the ability of Modified Frailty Index (mFI) to predict AEs in older patients undergoing elective posterior thoracolumbar fusion surgery. Methods: We retrospectively reviewed the results of 426 patients with the following diagnoses and follow-up evaluations of at least 12 months duration: lumbar disc herniation, 125; degenerative spondylolisthesis, 81; lumbar spinal canal stenosis, 187; and adult spinal deformities, 33. The cases were divided into two groups. The long spinal fusion (LSF) group was defined as ≥3 spinal levels with segmental pedicle-screw fixation. Short spinal fusion (SSF) were defined with at most two levels. The mFI used in the present study is an 11variable assessment. The association of frailty with AEs was determined after adjusting for known and suspected confounders. Results: Frailty was presented in 66 patients (15.5%) within the total population (LSF, 21.9% and SSF, 11.8%). Rates of AEs assessed in the study increased stepwise with an increase in the mFI for the two groups. The severity of frailty was an independent predictor of any, major, and minor complications in the LSF group and any, minor complication in the SSF group (P<0.05). A comparison of post-operative clinical outcomes showed that the ODI and SF-36 scores deteriorated as the mFI increased. Conclusion: Frailty was shown to be an independent predictor of AEs in older patients undergoing elective posterior thoracolumbar fusion surgery, especially for patients undergoing LSF.

The impact of frailty on perioperative outcomes in patients receiving short-level posterior lumbar interbody fusion: a stepwise propensity score matching analysis

“…With the aging population as well as the prevalence of frality among spine surgery patients, evaluating the impact of frailty on postoperative complications has been a hot topic. In a retrospective review of 426 patients undergoing elective posterior thoracolumbar fusion surgery, frailty, as distinguished by modi ed frailty index, Sun et al [25] showed that frailty was independently associated with adverse events. Shahrestani et al [24] reported that frail patients encountered higher rate of UTI (OR: 3.97, 95%CI: 3.21-4.95, p < 0.0001), infection (OR: 6.87, 95%CI: 4.55-10.86, p < 0.0001), and 30-day readmission (OR: 1.24, 95%CI: 1.02-1.51, p = 0.035).…”

The effect of age on short-term and mid-term outcomes after thoracoscopic Ivor Lewis esophagectomy: a propensity score-matched analysis

“…While chronological age per se has proven to be not predictive for operative success in many major abdominal surgeries, frailty irrespective of age has proven to be associated with higher rates of mortality, postoperative complications, length of stay in older surgical patients. The multimodal assessment and interventions and assessment in the form of preoperative (respiratory) prehabilitation are warranted in order to improve the outcome in elderly high-risk patients [ 10 , 23 – 25 ].…”

The measurements of frailty and their possible application to spinal conditions: a systematic review

“…The NOS score of the included studies ranged from 5-9. The most common sources of bias included absent follow-up time 24,26,27,33,35,36,45,53,56,62,64,69 , inadequate follow-up of cohorts 24,36,37,44,46,47,51,52,55,67,69 , not adjusting for confounding factors within the statistical model 25, 26, 31, 32, 37, 40, 43, 44, 46, 51, 54, 56, 62-64, 67, 69 , and poor representation of the cohort 26,32,37,44,45,47,50,51,55,63,[67][68][69] . Less common sources of bias included poor ascertainment of the exposure and outcome data [45][46][47]67 , insu cient follow-times for outcome(s) to occur 46 , and inadequate demonstration that the outcome was not present at the start of the study 31,46,51,52,55 .…”