Assessment of a Novel Adult Cervical Deformity Frailty Index as a Component of Preoperative Risk Stratification.


Journal Article

OBJECTIVE: To determine the value of a novel adult cervical deformity frailty index (CD-FI) in preoperative risk stratification. METHODS: We reviewed a prospective, multicenter database of adults with cervical spine deformity. We selected 40 variables to construct the CD-FI using a validated method. Patients were categorized as not frail (NF) (<0.2), frail (0.2-0.4), or severely frail (SF) (>0.4) according to CD-FI score. We performed multivariate logistic regression to determine the relationships between CD-FI score and incidence of complications, length of hospital stay, and discharge disposition. RESULTS: Of 61 patients enrolled from 2009 to 2015 with at least 1 year of follow-up, the mean CD-FI score was 0.26 (range 0.25-0.59). Seventeen patients were categorized as NF, 34 as frail, and 10 as SF. The incidence of major complications increased with greater frailty, with a gamma correlation coefficient of 0.25 (asymptotic standard error, 0.22). The odds of having a major complication were greater for frail patients (odds ratio 4.4; 95% confidence interval 0.6-32) and SF patients (odds ratio 43; 95% confidence interval 2.7-684) compared with NF patients. Greater frailty was associated with a greater incidence of medical complications and had a gamma correlation coefficient of 0.30 (asymptotic standard error, 0.26). Surgical complications, discharge disposition, and length of hospital stay did not correlate significantly with frailty. CONCLUSIONS: Greater frailty was associated with greater risk of major complications for patients undergoing cervical spine deformity surgery. The CD-FI may be used to improve the accuracy of preoperative risk stratification and allow for adequate patient counseling.

Full Text

Duke Authors

Cited Authors

  • Miller, EK; Ailon, T; Neuman, BJ; Klineberg, EO; Mundis, GM; Sciubba, DM; Kebaish, KM; Lafage, V; Scheer, JK; Smith, JS; Hamilton, DK; Bess, S; Shaffrey, CI; Ames, CP; International Spine Study Group,

Published Date

  • January 2018

Published In

Volume / Issue

  • 109 /

Start / End Page

  • e800 - e806

PubMed ID

  • 29107159

Pubmed Central ID

  • 29107159

Electronic International Standard Serial Number (EISSN)

  • 1878-8769

Digital Object Identifier (DOI)

  • 10.1016/j.wneu.2017.10.092


  • eng

Conference Location

  • United States