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Spine Rapid Fire Abstract

Spine

What Factors in Frailty Influence Ability of Frail Patients to Achieve Best Outcomes After Adult Spinal Deformity Correction?

Saturday, May 4, 2024
4:37 PM – 4:39 PM CT
Location:  S403ab
Disclosure(s):
Jamshaid M. Mir, MD: No financial relationships to disclose
Dean Chou, MD: Cerapedics: Grant/Research Support (Ongoing); Cervical Scoliosis Research Society: Grant/Research Support (Ongoing); Globus Medical: Research Grant (Ongoing); Medtronic: Research Grant (Ongoing); Nuvasive: Research Grant (Ongoing); Royal Biologics: Consultant (Ongoing); Spine Committee: Board Member/Officer/Trustee (Ongoing); Spinevision: Consultant (Ongoing); SpineWave: Consultant (Ongoing); Terumo: Consultant (Ongoing)
Peter G. Passias, MD: No financial relationships to disclose
Introduction: Prior research has shown that frailty exerts a ceiling effect on the highest achievable outcomes for adult spinal deformity patients. Examining the impact of specific and modifiable factors of frailty yields the possibility to lessen this ceiling effect.

Methods: Operative ASD patients with available baseline and 2-year data were isolated. Patients were stratified into Not Frail (NF), Frail (F), and Severely Frail (SF) based on the modified Frailty Index. Groups were further stratified based on 2-year ODI improvement from baseline with the most improved quartile designated “Highest”. Logistic and linear regressions determined which factors associated with severe frailty could predict achievement of best outcome.

Results: 393 ASD patients (mean 60.4±13.9 years, 80% female, BMI 27.0±5.4 kg/m2, CCI of 1.71±1.7, ASD-mFI of 6.6±4.8) who underwent surgical correction with on average 11.1±4.5 levels fused, decompression in 57%, and osteotomy in 71%. Surgical approach was mostly posterior-only (61.8% vs. 36.6% anterior-posterior, 1% anterior only, 0.5% MIS only). They were further classified as 55.2% Not Frail (NF), 31.0% Frail (F), and 13.7% Severely Frail (SF). In the most improved quartile group (Highest), they were classified as 12.5% NF (NF Highest), 17.8% Frail (F Highest), and 3.1% Severely Frail (SF Highest). Logistic regression with backward stepwise selection determined the following factors as predictive of Highest outcome for NF patients: optimal BMI (18.5-30 kg/m2; OR:1.34 [.031-.582], p=.007), no depression (OR:.224 [.050-.996], p=.049), no difficulty climbing stairs (OR:.286 [.123-.666], p=.004), and no difficulty getting dressed (OR:.309 [.099-.968], p=.044). For F patients, difficulty climbing stairs was the only significant predictor (OR:4.345 [1.441-13.096], p=.009). For SF patients, no modifiable frailty criteria were predictive of Highest outcome (all p>.05).

Conclusion : We analyzed the relationship between specific factors of the modified frailty index (ASD-mFI) and the highest achievable outcome for ASD patients. Patients who are not frail may benefit widely from optimization of almost any modifiable frailty criteria. Frail patients may benefit from improved physical fitness, while severely frail patients may not significantly benefit from optimization on a clinically perceptive level.