External validation of the adult spinal deformity (ASD) frailty index (ASD-FI).


Journal Article

PURPOSE: To assess the ability of the recently developed adult spinal deformity frailty index (ASD-FI) to predict odds of perioperative complications, odds of reoperation, and length of hospital stay after adult spinal deformity (ASD) surgery using a database other than the one used to create the index. METHODS: We used the ASD-FI to calculate frailty scores for 266 ASD patients who had minimum postoperative follow-up of 2 years in the European Spine Study Group (ESSG) database. Patients were enrolled from 2012 through 2013. Using ASD-FI scores, we categorized patients as not frail (NF) (< 0.3 points), frail (0.3-0.5 points), or severely frail (SF) (> 0.5 points). Multivariable logistic regression, adjusted for preoperative and surgical factors such as operative time and blood loss, was performed to determine the relationship between ASD-FI category and odds of major complications, odds of reoperation, and length of hospital stay. RESULTS: We categorized 135 patients (51%) as NF, 90 patients (34%) as frail, and 41 patients (15%) as SF. Overall mean ASD-FI score was 0.29 (range 0-0.8). The adjusted odds of experiencing a major intraoperative or postoperative complication (OR 4.5, 95% CI 2.0-10) or having a reoperation (OR 3.9, 95% CI 1.7-8.9) were higher for SF patients compared with NF patients. Mean hospital stay was 2.1 times longer (95% CI 1.8-2.4) for SF patients compared with NF patients. CONCLUSIONS: Greater patient frailty, as measured by the ASD-FI, is associated with longer hospital stays and greater odds of major complications and reoperation. These slides can be retrieved under Electronic Supplementary Material.

Full Text

Duke Authors

Cited Authors

  • Miller, EK; Vila-Casademunt, A; Neuman, BJ; Sciubba, DM; Kebaish, KM; Smith, JS; Alanay, A; Acaroglu, ER; Kleinstück, F; Obeid, I; Sánchez Pérez-Grueso, FJ; Carreon, LY; Schwab, FJ; Bess, S; Scheer, JK; Lafage, V; Shaffrey, CI; Pellisé, F; Ames, CP; European Spine Study Group, ; International Spine Study Group,

Published Date

  • September 2018

Published In

Volume / Issue

  • 27 / 9

Start / End Page

  • 2331 - 2338

PubMed ID

  • 29603013

Pubmed Central ID

  • 29603013

Electronic International Standard Serial Number (EISSN)

  • 1432-0932

Digital Object Identifier (DOI)

  • 10.1007/s00586-018-5575-3


  • eng

Conference Location

  • Germany