TY - JOUR
T1 - Development of a Modified Cervical Deformity Frailty Index
T2 - A Streamlined Clinical Tool for Preoperative Risk Stratification
AU - Passias, Peter G.
AU - Bortz, Cole A.
AU - Segreto, Frank A.
AU - Horn, Samantha R.
AU - Lafage, Renaud
AU - Lafage, Virginie
AU - Smith, Justin S.
AU - Line, Breton
AU - Kim, Han Jo
AU - Eastlack, Robert
AU - Hamilton, David Kojo
AU - Protopsaltis, Themistocles
AU - Hostin, Richard A.
AU - Klineberg, Eric O.
AU - Burton, Douglas C.
AU - Hart, Robert A.
AU - Schwab, Frank J.
AU - Bess, Shay
AU - Shaffrey, Christopher I.
AU - Ames, Christopher P.
N1 - Funding Information:
From the *Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY; †Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY; zDepartment of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA; §Denver International Spine Center, Denver, CO; {Division of Orthopedic Surgery, Scripps Clinic, La Jolla, CA; ||Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; **Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, TX; ††Department of Orthopedic Surgery, University of California, Davis, Davis, CA; zzDepartment of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS; §§Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA; {{Rocky Mountain Scoliosis and Spine, Denver, CO; and ||||Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA. Acknowledgment date: May 3, 2018. First revision date: June 11, 2018. Acceptance date: June 12, 2018. The manuscript submitted does not contain information about medical device(s)/drug(s). The International Spine Study Group supported the current work and is funded through research grants from DePuy Synthes and individual don- ations. Relevant financial activities outside the submitted work: board membership, consultancy, grants, payment for lecture, stocks, royalties. Address correspondence and reprint requests to Peter G. Passias, MD, Departments of Orthopedic and Neurological Surgery, Division of Spinal Surgery, Orthopedic Hospital, NYU Langone Medical Center, New York D eformity of the cervical spine is often debilitating, SpineInstitute,301East17thStreet,NewYork,NY10003; with severe cases characterized by cervical sagittal E-mail:Peter.Passias@nyumc.org malalignment, myelopathy, dysphagia, and loss of horizontal gaze.1 Given the wide range of etiologies and
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Study Design.Retrospective review.Objective.Develop a simplified frailty index for cervical deformity (CD) patients.Summary of Background Data.To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary.Methods.CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R2 were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: Not Frail (NF, <0.3), Frail (0.3-0.5), Severely Frail (SF, >0.5). Means comparison tests established correlations between frailty category and clinical outcomes.Results.Included: 121 CD patients (61 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]).Conclusion.Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.
AB - Study Design.Retrospective review.Objective.Develop a simplified frailty index for cervical deformity (CD) patients.Summary of Background Data.To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary.Methods.CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R2 were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: Not Frail (NF, <0.3), Frail (0.3-0.5), Severely Frail (SF, >0.5). Means comparison tests established correlations between frailty category and clinical outcomes.Results.Included: 121 CD patients (61 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]).Conclusion.Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.
KW - cervical deformity
KW - complications
KW - deformity
KW - frailty
KW - frailty index
KW - health deficit
KW - mortality
KW - outcomes
KW - risk
KW - risk index
KW - spine
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U2 - 10.1097/BRS.0000000000002778
DO - 10.1097/BRS.0000000000002778
M3 - Article
C2 - 30005037
AN - SCOPUS:85059828394
SN - 0362-2436
VL - 44
SP - 169
EP - 176
JO - Spine
JF - Spine
IS - 3
ER -