The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery

Shahrestani, Shane; Ton, Andy; Chen, Xiao T.; Ballatori, Alexander; Wang, Jeffrey C.; Buser, Zorica

doi:10.1007/s00586-021-06960-8

Cited by 16 publications

(14 citation statements)

References 33 publications

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“…In a prospective cohort analysis of 668 patients following spine surgery, frailty, as distinguished by risk assessment index, Agarwal et al [16] found that pre-frail and frail patients suffered longer LOS (3.9 d ± 3.6 vs 3.1 d ± 2.8, p < 0.001). Likewise, in a retrospective cohort study of geriatric patients receiving single-level lumbar fusion, after propensity score matching, Shahrestani et al [24] showed signi cantly greater LOS (9.9 ± 10.1 versus 4.0 ± 3.9, p < 0.0001) in frail patients than non-frail patients. In line with previous studies, we found that after propensity score matching, pre-frail patients had longer LOS (7.21 ± 2.99 versus 6.35 ± 2.66, p = 0.010) than non-frail patients and similar result was found between frail patients and pre-frail patients ( 8.23 ± 3.40 versus 7.06 ± 2.95, p = 0.019).…”

Section: Discussionmentioning

confidence: 94%

“…However, it cannot be ingored that frailty is signi cantly related to increasing age, which has been veri ed in previous studies [16][17][18]. On the other hand, in previous literatures, patients were dichotomized as non-frailty and pre-frality/frailty groups, without considering pre-frailty as an independent group [16,24]. Hence, in our study, PS matching for age, sex, ASA, fusion levels was used to guarantee comparable clinical characteristics between groups and pairwise comparisions was performed to compare the effects of frailty on complications.…”

Section: Discussionmentioning

confidence: 99%

“…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). Nevertheless, in a retrospective review of 5296 patients, Elsamadicy et al [18] reported that modi ed frailty index cannot independently predict complications.…”

Section: Discussionmentioning

confidence: 99%

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

Cui

Wang

et al. 2022

Preprint

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Background There were many literatures reporting the impact of frailty on postoperative complications, however, studies according to stepwise propensity score matching (PSM) to offset the influence of age were limited.Methods We gathered data for all patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. Accroding to Fried frailty phenotype, we segragated patients into three groups (not-frailty, pre-frailty, and frailty), then, stepwise propensity score matching for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Uni- and multivariate logistic regression were used to identify the impact of clinical demographics on postoperative complications.Results A total consecutive 559 patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PS matching, we found pre-frail patients were more vulnerable to develop urinary retention ( p = 0.031 ) and surgical site infection ( p = 0.021 ) than non-frail patients. Meanwhile, longer length of stay (LOS), ambulation time and removal of urinary catheter time were observed in pre-frail patients. However, there was significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reaction protein (CRP) and frailty status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with that of between pre-frail and frail patients.Conclusions In this study, after PS matching, we found higher rate of urinary retention and surgical site infection in pre-frail patients than that of non-frail patients. CRP was independently related to postoperative complications, while frailty status was only independently associated with postoperative complications between pre-frail and non-frail patients. And pre-frail/frail patients tended to have severer stress response than that of non-frail patients.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Cui

Wang

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In a prospective cohort analysis of 668 patients following spine surgery and frailty, as distinguished by the risk assessment index, Agarwal et al 16 found that pre-frail and frail patients had longer LOS (3.9 d ± 3.6 vs 3.1 d ± 2.8, p < 0.001). In a retrospective cohort study of geriatric patients undergoing single-level lumbar fusion, after PSM, Shahrestani et al 24 showed significantly greater LOS (9.9 ± 10.1 versus 4.0 ± 3.9, p < 0.0001) in frail than non-frail patients. In line with previous studies, we found that after PSM, pre-frail patients had longer LOS (7.21 ± 2.99 versus 6.35 ± 2.66, p = 0.010) than non-frail patients and a similar result was found between frail patients and pre-frail patients (8.23 ± 3.40 versus 7.06 ± 2.95, p = 0.019).…”

Section: Discussionmentioning

confidence: 98%

“…[16][17][18] On the other hand, in previous literatures, patients were dichotomized into non-frail and pre-frail/frail groups, without considering pre-frail as an independent group. 16,24 Therefore, we employed PSM for age, sex, ASA and fusion levels in the present study to guarantee comparable clinical characteristics between groups. Pairwise comparisons were performed to compare the effects of frailty on complications.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

Cui¹,

Wang²,

Wang³

et al. 2022

CIA

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Background: There are many studies on the impact of frailty on postoperative complications; however, there are few studies focusing on stepwise propensity score matching (PSM) to offset the influence of age. Methods: We gathered data for patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. According to the Fried frailty phenotype, we categorized patients into non-frail, pre-frail, and frail groups, then, stepwise PSM for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Univariate and multivariate logistic regressions were used to determine the impact of clinical demographics on postoperative complications. Results: A total of 559 consecutive patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PSM, we found that pre-frail patients were more vulnerable to develop urinary retention (p = 0.031) and surgical site infections (p = 0.021) than non-frail patients. Longer length of stay (LOS), delayed ambulation and removal of urinary catheter times were observed in pre-frail patients. However, there was a significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reactive protein (CRP) and frail status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with complications between pre-frail and frail patients. Conclusion: After PSM, we found higher rates of urinary retention and surgical site infections in pre-frail patients than in non-frail patients. CRP was independently related to postoperative complications, while frail status was only independently associated with postoperative complications between pre-frail and non-frail patients. Pre-frail/frail patients tended to have more severe stress responses than non-frail patients.

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The impact of frailty on postoperative complications in geriatric patients undergoing multi-level lumbar fusion surgery

et al. 2022

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The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery

Cited by 16 publications

References 33 publications

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

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

The Impact of Frailty on Perioperative Outcomes in Patients Receiving Short-Level Posterior Lumbar Interbody Fusion: A Stepwise Propensity Score Matching Analysis

The impact of frailty on postoperative complications in geriatric patients undergoing multi-level lumbar fusion surgery

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