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What predicts perioperative complications and 90-day readmission after cervical laminoplasty? Is it Frailty, ASA grade, Smoking, and/or Depression?

Friday, May 3, 2024

Presenting Author(s)

Michael E. Tawil, BS

Medical Student
University of California San Francisco
San Francisco, CA, US

Co-Author(s)

Alexander A. Aabedi, MD

Resident Physician
Department of Neurological Surgery, University of California, San Francisco
San Francisco, California, United States
VA

Vardhaan S. Ambati, MS

Medical Student
University of California San Francisco
San Jose, California, United States
Andrew K. Chan, MD

Assistant Professor of Neurological Surgery
Columbia University Irving Medical Center
New York, NY, US
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
TC

Timothy Chryssikos, MD, PHD

Assistant Professor
UCSF
Baltimore, Maryland, United States
Alysha Jamieson, BA

Research Analyst
University of California San Francisco
Raynham, Massachusetts, United States
Nishanth Krishnan, BS

Medical Student
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
VL

Vivian P. Le, MPH

Clinical Research Coordinator Supervisor
University of California, San Francisco
Vijay L. Letchuman, MD

Neurosurgery resident
UCSF
San Francisco, CA, US
Mohamed Macki, MD, MPH

Neurosurgeon
Cleveland Clinic
San Francisco, California, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
JR

Joshua Rivera, BA

Medical Student
UCSF
Los Angeles, California, United States
LT

Lee Tan, MD

Attending Surgeon
UCSF
Indianapolis, Indiana, United States
ST

Seth Tigchelaar, MD

Neurosurgery resident
UCSF
Stanford, California, United States

Introduction: The modified Frailty Index-5 (mFI-5) is a simple assessment tool used in the preoperative setting to assess patient health and has been correlated to clinical outcomes after surgery. We aimed to determine if the mFI-5 predicts perioperative complications and readmission within 90 days following posterior cervical laminoplasty.

Methods: 302 patients who underwent open-door laminoplasty for cervical spondylitic myelopathy at a single quaternary center were retrospectively reviewed. Demographic, patient-reported (mJOA, EQ5D), and surgical data were collected. The mFI-5 was used to quantify patient frailty. Univariate and multivariate logistic regression analyses were used to evaluate mFI-5 and other clinically relevant variables and to compare frailty with other measures (ASA grade, smoking, and depression).

Results: Mean age and BMI were 63.5 and 28.6, respectively. There were 188 males and 114 females. Rate of readmission within 90 days was 9.9%. Univariate logistic regression showed a significant association between 90-day readmission and depression (OR 3.27, p=0.03). mFI-5 was more predictive than ASA grade for 90-day readmission (OR 1.40, p=0.06 vs. OR 0.57, p=0.16) on univariate analysis. Multivariate logistic regression including age, ASA grade, mFI-5, and depression showed that only depression was significantly associated with 90-day readmission (OR 2.60, p=0.04). The overall rate of complications was 14.6%. Univariate logistic regression showed significant associations between complications and smoking (OR 2.41, p=0.05) and mFI-5 (OR 1.64, p=0.001). Multivariate logistic regression including age, ASA grade, mFI-5, and smoking showed that both mFI-5 (OR 1.56, p< 0.01) and smoking (OR 4.79, p< 0.01) were significantly associated with complication after cervical laminoplasty.

Conclusion : Smoking status and patient frailty (mFI-5) outperformed ASA grade and depression for predicting perioperative complications following cervical laminoplasty. However, for 90-day readmission, depression was the only significant predictor of 90-day readmission after cervical laminoplasty.