External Validation of the Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) in the Scoli-RISK-1 Patient Database

TY - JOUR

T1 - External Validation of the Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) in the Scoli-RISK-1 Patient Database

AU - Miller, Emily K

AU - Lenke, Lawrence G

AU - Neuman, Brian J

AU - Sciubba, Daniel M

AU - Kebaish, Khaled M

AU - Smith, Justin S

AU - Qiu, Yong

AU - Dahl, Benny T

AU - Pellisé, Ferran

AU - Matsuyama, Yukihiro

AU - Carreon, Leah Y

AU - Fehlings, Michael G

AU - Cheung, Kenneth M

AU - Lewis, Stephen

AU - Dekutoski, Mark B

AU - Schwab, Frank J

AU - Boachie-Adjei, Oheneba

AU - Mehdian, Hossein

AU - Bess, Shay

AU - Shaffrey, Christopher I

AU - Ames, Christopher P

AU - AOSpine Knowledge Forum Deformity, the International Spine Study Group

PY - 2018

Y1 - 2018

N2 - STUDY DESIGN: Analysis of a prospective multicenter database.OBJECTIVE: To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index.SUMMARY OF BACKGROUND DATA: Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery.METHODS: Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3-0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay.RESULTS: The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients.CONCLUSION: Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures.LEVEL OF EVIDENCE: 2.

AB - STUDY DESIGN: Analysis of a prospective multicenter database.OBJECTIVE: To assess the ability of the recently created Adult Spinal Deformity (ASD) Frailty Index (ASD-FI) to predict odds of major complications and length of hospital stay for patients who had more severe preoperative deformity and underwent more invasive ASD surgery compared with patients in the database used to create the index.SUMMARY OF BACKGROUND DATA: Accurate preoperative estimates of risk are necessary given the high complication rates currently associated with ASD surgery.METHODS: Patients were enrolled by participating institutions in Europe, Asia, and North America from 2009 to 2011. ASD-FI scores were used to classify 267 patients as not frail (NF) (<0.3), frail (0.3-0. 5), or severely frail (SF) (>0.5). Multivariable logistic regression, adjusted for preoperative and surgical covariates such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and incidence of major complications, overall incidence of complications, and length of hospital stay.RESULTS: The mean ASD-FI score was 0.3 (range, 0-0.7). We categorized 105 patients as NF, 103 as frail, and 59 as SF. The adjusted odds of developing a major complication were higher for SF patients (odds ratio = 4.4; 95% CI 2.0, 9.9) compared with NF patients. After adjusting for covariates, length of hospital stay for SF patients increased by 19% (95% CI 1.4%, 39%) compared with NF patients. The odds of developing a major complication or having increased length of stay were similar between frail and NF patients.CONCLUSION: Greater patient frailty, as measured by the ASD-FI, is associated with a longer hospital stay and greater risk of major complications among patients who have severe preoperative deformity and undergo invasive surgical procedures.LEVEL OF EVIDENCE: 2.

KW - Adult

KW - Aged

KW - Databases, Factual/statistics & numerical data

KW - Female

KW - Frailty

KW - Humans

KW - Length of Stay/statistics & numerical data

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Neurosurgical Procedures/methods

KW - Postoperative Complications

KW - Prospective Studies

KW - Spinal Diseases

U2 - 10.1097/BRS.0000000000002717

DO - 10.1097/BRS.0000000000002717

M3 - Journal article

C2 - 29762340

SN - 0362-2436

VL - 43

SP - 1426

EP - 1431

JO - Spine

JF - Spine

IS - 20

ER -