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19-03-2024 | Spinal Surgery | Original Article

Frailty is not an independent risk factor for worse clinical outcomes in lumbar spinal surgery: a prospective cohort study

Authors: Hong Kyung Shin, Ji Yeon Baek, Jeoung Hee Kim, Danbi Park, Sang Ryong Jeon, Sung Woo Roh, Il-Young Jang, Jin Hoon Park

Published in: European Spine Journal

Abstract

Purpose

Recently, many studies revealed that frailty affects unfavorably on postoperative outcomes in lumbar spinal diseases. This study aimed to investigate the relationship between frailty and clinical outcomes while identifying risk factors associated with worse clinical outcomes following lumbar spinal surgery.

Methods

From March 2019 to February 2021, we prospectively enrolled eligible patients with degenerative lumbar spinal diseases requiring surgery. Frailty was assessed preoperatively. To identify the impact of frailty on lumbar spinal diseases, clinical outcomes, which were measured with patient-reported outcomes (PROs) and postoperative complications, were compared according to the frailty. PROs were assessed preoperatively and one year postoperatively. In addition, risk factors for preoperative and postoperative worse clinical outcomes were investigated.

Results

PROs were constantly lower in the frail group than in the non-frail group before and after surgery, and the change of PROs between before and after surgery and postoperative complications were not different between the groups. In addition, frailty was a persistent risk factor for postoperative worse clinical outcome before and after surgery in lumbar spinal surgery.

Conclusion

Frailty persistently affects the clinical outcome negatively before and after surgery in lumbar spinal surgery. However, as the change of the clinical outcome is not different between the frail group and the non-frail group, it is difficult to interpret whether the frail patients are vulnerable to the surgery. In conclusion, frailty is not an independent risk factor for worse clinical outcome in lumbar spinal surgery.

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Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI (2008) Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. J Am Geriatr Soc 56:898–903. https://doi.org/10.1111/j.1532-5415.2008.01656.xCrossRefPubMedPubMedCentral

Lee L, Patel T, Hillier LM, Maulkhan N, Slonim K, Costa A (2017) Identifying frailty in primary care: a systematic review. Geriatr Gerontol Int 17:1358–1377. https://doi.org/10.1111/ggi.12955CrossRefPubMed

Lee DH, Buth KJ, Martin BJ, Yip AM, Hirsch GM (2010) Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation 121:973–978. https://doi.org/10.1161/circulationaha.108.841437CrossRefPubMed

Obeid NM, Azuh O, Reddy S, Webb S, Reickert C, Velanovich V, Horst HM, Rubinfeld I (2012) Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches. J Trauma Acute Care Surg 72:878–883. https://doi.org/10.1097/TA.0b013e31824d0f70CrossRefPubMed

Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ: Can Med Assoc J 173:489–495. https://doi.org/10.1503/cmaj.050051CrossRef

Kroenke K, Spitzer RL, Williams JBW (2003) The patient health questionnaire-2: validity of a two-item depression screener 41:1284–1292. https://doi.org/10.1097/01.Mlr.0000093487.78664.3c

Kitzen J, Verbiest V, Buil I, Schotanus MGM, van Rietbergen B, van Kuijk SMJ, van Rhijn LW, Willems P (2020) Subsidence after total lumbar disc replacement is predictable and related to clinical outcome. Eur Spine J 29:1544–1552. https://doi.org/10.1007/s00586-020-06443-2CrossRefPubMed

Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 38:E803–E812. https://doi.org/10.1097/BRS.0b013e318292b7b9CrossRefPubMed

Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25:2940–2952; discussion 2952. https://doi.org/10.1097/00007632-200011150-00017

10.

Grotle M, Småstuen MC, Fjeld O, Grøvle L, Helgeland J, Storheim K, Solberg TK, Zwart JA (2019) Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway. BMJ Open 9:e028743. https://doi.org/10.1136/bmjopen-2018-028743CrossRefPubMedPubMedCentral

11.

Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S (2018) Epidemiological trends in spine surgery over 10 years in a multicenter database. Eur Spine J 27:1698–1703. https://doi.org/10.1007/s00586-018-5513-4CrossRefPubMed

12.

McIsaac DI, Jen T, Mookerji N, Patel A, Lalu MM (2017) Interventions to improve the outcomes of frail people having surgery: a systematic review. PLoS ONE 12:e0190071. https://doi.org/10.1371/journal.pone.0190071CrossRefPubMedPubMedCentral

13.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156. https://doi.org/10.1093/gerona/56.3.m146CrossRefPubMed

14.

Charest-Morin R, Street J, Zhang H, Roughead T, Ailon T, Boyd M, Dvorak M, Kwon B, Paquette S, Dea N, Fisher CG, Flexman AM (2018) Frailty and sarcopenia do not predict adverse events in an elderly population undergoing non-complex primary elective surgery for degenerative conditions of the lumbar spine. Spine J 18:245–254. https://doi.org/10.1016/j.spinee.2017.07.003CrossRefPubMed

15.

Bourassa-Moreau É, Versteeg A, Moskven E, Charest-Morin R, Flexman A, Ailon T, Dalkilic T, Fisher C, Dea N, Boyd M, Paquette S, Kwon B, Dvorak M, Street J (2020) Sarcopenia, but not frailty, predicts early mortality and adverse events after emergent surgery for metastatic disease of the spine. Spine J 20:22–31. https://doi.org/10.1016/j.spinee.2019.08.012CrossRefPubMed

16.

Beauchamp-Chalifour P, Flexman AM, Street JT, Fisher CG, Ailon T, Dvorak MF, Kwon BK, Paquette SJ, Dea N, Charest-Morin R (2021) The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery. J Neurosurg Spine:1–9. https://doi.org/10.3171/2021.2.Spine201879

17.

Leven DM, Lee NJ, Kothari P, Steinberger J, Guzman J, Skovrlj B, Shin JI, Caridi JM, Cho SK (2016) Frailty index is a significant predictor of complications and mortality after surgery for adult spinal deformity. Spine 41:E1394–E1401. https://doi.org/10.1097/brs.0000000000001886CrossRefPubMed

18.

Ali R, Schwalb JM, Nerenz DR, Antoine HJ, Rubinfeld I (2016) Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J Neurosurg Spine 25:537–541. https://doi.org/10.3171/2015.10.Spine14582CrossRefPubMed

19.

Kweh B, Lee H, Tan T, O’Donohoe T, Mathew J, Fitzgerald M, Gantner D, Kambourakis T, Tew K, Hunn M, Rosenfeld J, Tee J (2021) Spinal surgery in patients aged 80 years and older: risk stratification using the modified frailty index. Global Spine J 11:525–532. https://doi.org/10.1177/2192568220914877CrossRefPubMed

20.

Amirdelfan K, Webster L, Poree L, Sukul V, McRoberts P (2017) Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach. Spine 42(Suppl 14):S41–S52. https://doi.org/10.1097/brs.0000000000002217CrossRefPubMed

21.

Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8:968–974. https://doi.org/10.1016/j.spinee.2007.11.006CrossRefPubMed

22.

Karlsson T, Försth P, Skorpil M, Pazarlis K, Öhagen P, Michaëlsson K, Sandén B (2022) Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up. Bone Joint J 104-b:1343–1351. https://doi.org/10.1302/0301-620x.104b12.Bjj-2022-0340.R1CrossRefPubMedPubMedCentral

23.

Gadjradj PS, Basilious M, Goldberg JL, Sommer F, Navarro-Ramirez R, Mykolajtchuk C, Ng AZ, Medary B, Hussain I, Härtl R (2023) Decompression alone versus decompression with fusion in patients with lumbar spinal stenosis with degenerative spondylolisthesis: a systematic review and meta-analysis. Eur Spine J 32:1054–1067. https://doi.org/10.1007/s00586-022-07507-1CrossRefPubMed

Title: Frailty is not an independent risk factor for worse clinical outcomes in lumbar spinal surgery: a prospective cohort study
Authors: Hong Kyung Shin
Ji Yeon Baek
Jeoung Hee Kim
Danbi Park
Sang Ryong Jeon
Sung Woo Roh
Il-Young Jang
Jin Hoon Park
Publication date: 19-03-2024
Publisher: Springer Berlin Heidelberg
Keyword: Spinal Surgery
Published in: European Spine Journal
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-024-08202-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Frailty is not an independent risk factor for worse clinical outcomes in lumbar spinal surgery: a prospective cohort study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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