Impact of Controlled Versus Uncontrolled mFI-5 Frailty on Perioperative Complications After Adult Spinal Deformity Surgery.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-10-01 Epub Date: 2024-03-27 DOI:10.1097/BSD.0000000000001595

Jarod Olson, Kevin C Mo, Jessica Schmerler, Wesley M Durand, Khaled M Kebaish, Richard L Skolasky, Brian J Neuman

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Abstract

Study design: Retrospective review.

Objectives: We substratified the mFI-5 frailty index to reflect controlled and uncontrolled conditions and assess their relationship to perioperative complications.

Summary of background data: Risk assessment before adult spinal deformity (ASD) surgery is critical because the surgery is highly invasive with a high complication rate. Although frailty is associated with risk of surgical complications, current frailty measures do not differentiate between controlled and uncontrolled conditions.

Methods: Frailty was calculated using the mFI-5 index for 170 ASD patients with fusion of ≥5 levels. Uncontrolled frailty was defined as blood pressure >140/90 mm Hg, HbA1C >7% or postprandial glucose >180 mg/dL, or recent chronic obstructive pulmonary disease (COPD) exacerbation, while on medication. Patients were divided into nonfrailty, controlled frailty, and uncontrolled frailty cohorts. The primary outcome measure was perioperative major and wound complications. Bivariate analysis was performed. Multivariable analysis assessed the relationship between frailty and perioperative complications.

Results: The cohorts included 97 nonfrail, 54 controlled frail, and 19 uncontrolled frail patients. Compared with nonfrail patients, patients with uncontrolled frailty were more likely to have age older than 60 years (84% vs. 24%), hyperlipidemia (42% vs. 20%), and Oswestry Disability Index (ODI) score >42 (84% vs. 52%) ( P <0.05 for all). Controlled frailty was associated with those older than 60 years (41% vs. 24%) and hyperlipidemia (52% vs. 20%) ( P <0.05 for all). On multivariable regression analysis controlling for hyperlipidemia, functional independence, motor weakness, ODI>42, and age older than 60 years, patients with uncontrolled frailty had greater odds of major complications (OR 4.24, P =0.03) and wound complications (OR 9.47, P =0.046) compared with nonfrail patients. Controlled frailty was not associated with increased risk of perioperative complications ( P >0.05 for all).

Conclusions: Although patients with uncontrolled frailty had higher risk of perioperative complications compared with nonfrail patients, patients with controlled frailty did not, suggesting the importance of controlling modifiable risk factors before surgery.

Level of evidence: 3.

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受控与不受控制的 mFI-5 衰弱对成人脊柱畸形手术后围手术期并发症的影响。

研究设计回顾性研究：我们对mFI-5虚弱指数进行了分层，以反映受控和非受控情况，并评估其与围手术期并发症的关系：成人脊柱畸形（ASD）手术前的风险评估至关重要，因为该手术创伤大、并发症发生率高。虽然虚弱程度与手术并发症风险有关，但目前的虚弱程度测量方法并不能区分受控和非受控情况：采用 mFI-5 指数计算了 170 名融合≥5 个层面的 ASD 患者的虚弱程度。未受控制的虚弱定义为血压 >140/90 mm Hg、HbA1C >7% 或餐后血糖 >180 mg/dL，或近期慢性阻塞性肺病 (COPD) 恶化，同时正在服药。患者被分为非虚弱组、受控虚弱组和未受控虚弱组。主要结果指标是围手术期的主要并发症和伤口并发症。进行了双变量分析。多变量分析评估了虚弱与围手术期并发症之间的关系：队列中包括 97 名非体弱患者、54 名体弱受控患者和 19 名体弱未受控患者。与非虚弱患者相比，未受控制的虚弱患者更有可能患有年龄大于 60 岁（84% 对 24%）、高脂血症（42% 对 20%）和 Oswestry 残疾指数（ODI）评分大于 42（84% 对 52%）（P42，年龄大于 60 岁，未受控制的虚弱患者与非虚弱患者相比，发生主要并发症（OR 4.24，P=0.03）和伤口并发症（OR 9.47，P=0.046）的几率更高）。受控的虚弱与围手术期并发症风险的增加无关（P>0.05）：结论：尽管与非体弱患者相比，未控制体弱的患者围手术期并发症的风险更高，但控制体弱的患者并不如此，这表明手术前控制可改变的风险因素非常重要：3.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.