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Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity

Yagi, Mitsuru, MD, PhD∗,†,‡; Michikawa, Takehiro, MD, PhD§; Hosogane, Naobumi, MD, PhD‡,¶; Fujita, Nobuyuki, MD, PhD∗,‡; Okada, Eijiro, MD, PhD∗,‡; Suzuki, Satoshi, MD, PhD∗,‡; Tsuji, Osahiko, MD, PhD∗,‡; Nagoshi, Narihito, MD, PhD∗,‡; Asazuma, Takashi, MD, PhD; Tsuji, Takashi, MD, PhD‡,||; Nakamura, Masaya, MD, PhD∗,‡; Matsumoto, Morio, MD, PhD∗,‡; Watanabe, Kota, MD, PhD∗,‡

doi: 10.1097/BRS.0000000000002929
DEFORMITY
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Study Design. A retrospective multicenter database review of 240 consecutive patients at least 21 years of age (mean 58 ± 17, range 22–79) who underwent surgery for adult spinal deformity (ASD) and were followed at least 2 years.

Objective. To investigate how treatment for frailty affects complications in surgery for ASD.

Summary of Background Data. Several recent studies have focused on associations between frailty and surgical complications. However, it is not clear whether treating frailty affects complication rates in surgery for ASD.

Methods. Patients were categorized as robust (R group), prefrail, or frail based on the modified frailty index (mFI); prefrail and frail patients were divided by good control of frailty (G group), defined as treatment following the appropriate guidelines for each mFI factor, or poorly controlled frailty (PC group). We compared clinical outcomes and perioperative and 2-year complications between the three groups.

Results. Of the 240 patients, 142 (59%) were robust, 81 (34%) were prefrail, and 17 (7%) were frail. Among the frail and prefrail patients, 71 (72%) were classified as G and 27 (28%) as PC. The perioperative complication rate was similar in the G and PC groups (32% vs. 37%) but was significantly lower in the R group (15%, P < 0.01). The age- and sex-adjusted odds ratio for 2-year complications was not different in the P group when the G group was referenced (odds ratio 1.3 [0.5–3.2], P = 0.63). In the G and PC groups, which had similar 2-year outcomes, the Scoliosis Research Society-22 function and total scores were significantly lower than in the R group (function: R 3.9 ± 0.7, G 3.5 ± 0.7, P 3.3 ± 0.6; total: R 3.9 ± 0.6, 3.7 ± 0.7, 3.4 ± 0.6; P < 0.01).

Conclusion. Regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.

Level of Evidence: 4

Retrospective review of 240 surgically consecutive ASD patients from multicenter database revealed that regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.

Department of Orthopedic Surgery, Keio University School of Medicine

Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center

Keio Spine Research Group

§Department of Environmental and Occupational Health, School of Medicine, Toho University

Department of Orthopedic Surgery, Kyorin University School of Medicine, Tokyo

||Department of Orthopedic Surgery, Fujita Health University, Nagoya, Japan.

Address correspondence and reprint requests to Kota Watanabe, MD, PhD, Department of Orythopedic Surgey, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku Tokyo Japan Kota Watanabe; E-mail: KW19751@keio.jp

Received 28 September, 2018

Revised 9 October, 2018

Accepted 17 October, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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