Which Frailty Components Have the Greatest Influence on the Ability of Frail Patients to Achieve Optimal Outcomes After Adult Spinal Deformity Correction?: A Retrospective Analysis

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
KM

Kim Mcfarland

Florida, United States
PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
SO

Stephane Owusu-Sarpong, MD

Orthopedic Surgery Resident
NYU Langone Health, United States
OO

Oluwatobi Onafowokan

United Kingdom
DR

Djani Robertson

Resident Physician, United States
RL

Renaud Lafage, MS

Senior Biomedical engineer
Lenox Hill Hospital
new york, New York, United States
Virginie Lafage, PhD

AVP, Clinical Research
Lenox Hill | Northwell
Hospital for Special Surgery
New York, New York, United States
TR

Timothy Roberts

Orthopaedic Spine Surgeon
Westbury, New York, United States
AM

Angel Macagno

United States
NP

Nicholas Post

United States
AD

Alexandre De Moura

United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: Prior research has shown that frailty exerts a ceiling effect on the highest achievable outcomes for adult spinal deformity patients. Examining the impact of specific and modifiable factors of frailty yields the possibility to lessen this ceiling effect.

Purpose: To determine what factors influence achievement of best outcomes after adult spinal deformity surgery.

Methods: Operative adult spinal deformity patients with available baseline and 2-year demographic, radiographic, surgical outcomes, complications, and reoperations data were isolated. Patients were stratified into Not Frail (NF), Frail (F), and Severely Frail (SF) based on the modified Frailty Index (ASD-mFI). These groups were further stratified based on 2-year ODI improvement from baseline with the most improved quartile designated “Highest”. Logistic and linear regressions were used to determine which factors associated with severe frailty can predict achievement of their best possible outcome.

Results: 393 ASD patients (mean 60.4±13.9 years, 80% female, BMI 27.0±5.4 kg/m2, CCI of 1.71±1.7, ASD-mFI of 6.6±4.8) who underwent surgical correction with on average 11.1±4.5 levels fused, decompression in 57%, and osteotomy in 71%. The surgical approach was mostly posterior-only (61.8% vs. 36.6% anterior-posterior, 1% anterior only, 0.5% MIS only). They were further classified as 55.2% Not Frail (NF), 31.0% Frail (F), and 13.7% Severely Frail (SF). In the most improved quartile group (Highest), they were classified as 12.5% NF (NF Highest), 17.8% Frail (F Highest), and 3.1% Severely Frail (SF Highest). Logistic regression with backward stepwise selection determined the following factors as predictive of Highest outcome for NF patients: optimal BMI (18.5-30 kg/m2; OR:1.34 [.031-.582], p=.007), no depression (OR:.224 [.050-.996], p=.049), no difficulty climbing stairs (OR:.286 [.123-.666], p=.004), and no difficulty getting dressed (OR:.309 [.099-.968], p=.044). For F patients, difficulty climbing stairs was the only significant predictor (OR:4.345 [1.441-13.096], p=.009). For SF patients, no modifiable frailty criteria were predictive of Highest outcome (all p>.05).

Conclusions: This study analyzed the relationship between specific factors of the modified frailty index (ASD-mFI) and the highest achievable outcome for adult spinal deformity patients. Patients who are not frail may benefit widely from optimization of almost any modifiable frailty criteria. Frail patients may benefit from improved physical fitness. Severely frail patients may not benefit from optimization of these modifiable criteria.