The 5-Item Modified Frailty Index Is Predictive of Severe Adverse Events in Patients Undergoing Surgery for Adult Spinal Deformity

被引：108

作者：

Yagi, Mitsuru ^{[1
,2
,3
]}

Michikawa, Takehiro ^{[4
]}

Hosogane, Naobumi ^{[3
,5
]}

Fujita, Nobuyuki ^{[1
,3
]}

Okada, Eijiro ^{[1
,3
]}

Suzuki, Satoshi ^{[1
,3
]}

Tsuji, Osahiko ^{[1
,3
]}

Nagoshi, Narihito ^{[1
,3
]}

Asazuma, Takashi ^{[2
]}

Tsuji, Takashi ^{[3
,6
]}

Nakamura, Masaya ^{[1
,3
]}

Matsumoto, Morio ^{[1
,3
]}

Watanabe, Kota ^{[1
,3
]}

机构：

[1] Keio Univ, Dept Orthoped Surg, Sch Med, Tokyo, Japan

[2] Natl Hosp Org, Dept Orthoped Surg, Murayama Med Ctr, Tokyo, Japan

[3] Keio Spine Res Grp, Tokyo, Japan

[4] Toho Univ, Sch Med, Dept Environm & Occupat Hlth, Tokyo, Japan

[5] Kyorin Univ, Dept Orthoped Surg, Sch Med, Tokyo, Japan

[6] Fujita Hlth Univ, Dept Orthoped Surg, Toyoake, Aichi, Japan

来源：

SPINE | 2019年 / 44卷 / 18期

关键词：

ASD plus SAE; complication; serious adverse event; severe adverse event; SURGICAL-OUTCOMES; RISK-FACTORS; COMPLICATIONS; MORTALITY; MORBIDITY; CLASSIFICATION; IMPACT;

D O I：

10.1097/BRS.0000000000003063

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 +/- 19 yrs, 91% female, follow-up 4.3 +/- 1.9 yrs) from a multicenter database. Objective. To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs). Summary of Background Data. Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven. Methods. SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients' frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients. Results. Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to >= 2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3-3.7). Conclusion. The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients.

引用

页码：E1083 / E1091

页数：9

共 41 条

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