Neurosurgery resident University of Florida Gainesville, Florida, United States
Introduction: Cervical myelopathy has been demonstrated to be a predictor of adverse outcomes in patients undergoing cervical spine surgery. Recently, frailty – a multi-dimensional syndrome of physiological decline – has been identified as another independent factor that is associated with poor post-operative outcomes in patients undergoing spinal surgery. Multiple frailty assessment tools are currently in use, including the Fried phenotype, the modified frailty index-11 (mFI-11), and the modified 5-item frailty index (mFI-5). No study has compared these various frailty assessment tools and severity of myelopathy in predicting post-operative outcomes. This study evaluates the association between frailty and myelopathy with post-operative outcomes after posterior cervical decompression (PCD) surgery.
Methods: Patients >65 years who underwent PCD surgery between July 2015 and July 2021 were included. Cervical myelopathy was assessed with the Nurick grade. Patients’ Fried phenotypes, mFI-11 scores, and mFI-5 scores were collected. The primary outcome was an increased number (>2) of post-operative complications, while secondary outcomes included a prolonged length of stay (pLOS) >3 days, a non-home discharge disposition, and delayed return of physiological function >6 days. Combinations of scores, including Fried+Nurick, Nurick+mFI-11, and Nurick+mFI-5, were also calculated to determine the best predictors of primary and secondary outcomes. Receiver operator curves (ROC) and precision recall (PR) curves were analyzed for predictive power via area under the curve (AUC).
Results: 144 patients (104 laminectomy and fusions and 40 laminoplasties) were included. The Fried+Nurick score (ROC-AUC: 0.657; PR-AUC: 0.479) was the most predictive score of >2 complications. For a pLOS >3 days, the Fried phenotype alone (ROC-AUC: 0.656; PR-AUC: 0.810) was most predictive. For a non-home discharge disposition, the Fried+Nurick score (ROC-AUC: 0.752; PR-AUC: 0.532) and the Fried phenotype (ROC-AUC: 0.733; PR-AUC: 0.551) were found to be the most predictive. No measure was found to be a reliable predictor of a delayed return of physiological function.
Conclusion : The Fried phenotype alone, and in combination with the Nurick grade, was more predictive of post-operative outcomes than myelopathy alone or other commonly used frailty assessment tools (mFI-11 and mFI-5). The Fried frailty score may be a useful adjunct for pre-operative risk assessment and patient counseling prior to PCD surgery.
