Impact of Frailty on Morbidity and Mortality in Adult Patients Presenting with an Acute Traumatic Cervical Spinal Cord Injury

OBJECTIVE: The aim of this study was to determine if baseline frailty was an independent predictor of adverse events (AEs) and in-hospital mortality in patients being treated for acute cervical spinal cord injury (SCI). METHODS: A retrospective cohort study was performed using the National Trauma Database (NTDB) from 2017. Adult patients (>18 years old) with acute cervical SCI were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic and procedural coding systems. Patients were categorized into 3 cohorts based on the criteria of the 5-item modified frailty index (mFI5): mFI = 0, mFI = 1, or mFIz2. Patient demographics, comorbidities, type of injury, diagnostic and treatment modality, AEs, and in-patient mortality were assessed. A multivariate logistic regression analysis was used to identify independent predictors of in-hospital AEs and mortality. RESULTS: Of 8986 patients identified, 4990 (55.5%) were classified as mFI = 0, 2328 (26%) as mFI = 1, and 1668 (18.5%) as mFIz2. On average, the mFIz2 cohort was 5 years older than the mFI = 1 cohort and 22 years older than the mFI = 0 cohort (P < 0.001). Most patients in each cohort sustained either complete SCI or central cord syndrome after a fall or transport accident (mFI = 0, 77.31% vs. mFI = 1, 89.5% vs. mFIz2, 93.65%). With respect to in hospital events, the proportion of patients who experienced any AE increased significantly along with frailty score (mFI = 0, 30.42% vs. mFI = 1, 31.74% vs. mFIz2, 34.95%; P < 0.001). In-hospital mortality followed a similar trend, increasing with frailty score (mFI = 0, 10.53% vs. mFI = 1, 11.33% vs. mFIz2, 16.23%; P < 0.001). On multivariate regression analysis, both mFI = 1 1.21 (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4; P = 0.008) and mFIz2 (OR, 1.23; 95% CI, 1.05-1.45; P = 0.012) predicted AEs, whereas only mFIz2 was found to be a predictor for in-hospital mortality (OR, 1.45; 95% CI, 1.141.83; P = 0.002). CONCLUSIONS: Increasing frailty is associated with an increased risk of AEs and in-hospital mortality in patients u ndergoing treatment for cervical SCI.