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Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up.

Publication ,  Journal Article
Pierce, KE; Passias, PG; Alas, H; Brown, AE; Bortz, CA; Lafage, R; Lafage, V; Ames, C; Burton, DC; Hart, R; Hamilton, K; Kelly, M; Hostin, R ...
Published in: Spine (Phila Pa 1976)
April 1, 2020

STUDY DESIGN: Retrospective review of a prospective database. OBJECTIVE: The aim of this study was to evaluate postop clinical recovery among adult spinal deformity (ASD) patients between frailty states undergoing primary procedures SUMMARY OF BACKGROUND DATA.: Frailty severity may be an important determinant for impaired recovery after corrective surgery. METHODS: It included ASD patients with health-related quality of life (HRQLs) at baseline (BL), 1 year (1Y), and 3 years (3Y). Patients stratified by frailty by ASD-frailty index scale 0-1(no frailty: <0.3 [NF], mild: 0.3-0.5 [MF], severe: >0.5 [SF]). Demographics, alignment, and SRS-Schwab modifiers were assessed with χ/paired t tests to compare HRQLs: Scoliosis Research Society 22-question Questionnaire (SRS-22), Numeric Rating Scale (NRS) Back/Leg Pain, Oswestry Disability Index (ODI). Area-under-the-curve (AUC) method generated normalized HRQL scores at baseline (BL) and f/u intervals (1Y, 3Y). AUC was calculated for each f/u, and total area was divided by cumulative f/u, generating one number describing recovery (Integrated Health State [IHS]). RESULTS: A total of 191 patients were included (59 years, 80% females). Breakdown of patients by frailty status: 43.6% NF, 40.8% MF, 15.6% SF. SF patients were older (P = 0.003), >body mass index (P = 0.002). MF and SF were significantly (P < 0.001) more malaligned at BL: pelvic tilt (NF: 21.6°; MF: 27.3°; SF: 22.1°), pelvic incidence and lumbar lordosis (7.4°, 21.2°, 19.7°), sagittal vertical axis (31 mm, 87 mm, 82 mm). By SRS-Schwab, NF were mostly minor (40%), and MF and SF markedly deformed (64%, 57%). Frailty groups exhibited BL to 3Y improvement in SRS-22, ODI, NRS Back/Leg (P < 0.001). After HRQL normalization, SF had improvement in SRS-22 at year 1 and year 3 (P < 0.001), and NRS Back at 1Y. 3Y IHS showed a significant difference in SRS-22 (NF: 1.2 vs. MF: 1.32 vs. SF: 1.69, P < 0.001) and NRS Back Pain (NF: 0.52, MF: 0.66, SF: 0.6, P = 0.025) between frailty groups. SF had more complications (79%). SF/marked deformity had larger invasiveness score (112) compared to MF/moderate deformity (86.2). Controlling for baseline deformity and invasiveness, SF showed more improvement in SRS-22 IHS (NF: 1.21, MF: 1.32, SF: 1.66, P < 0.001). CONCLUSION: Although all frailty groups exhibited improved postop disability/pain scores, SF patients recovered better in SRS-22 and NRS Back. Despite SF patients having more complications and larger invasiveness scores, they had overall better patient-reported outcomes, signifying that with frailty severity, patients have more room for improvement postop compared to BL quality of life. LEVEL OF EVIDENCE: 3.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

April 1, 2020

Volume

45

Issue

7

Start / End Page

E397 / E405

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surveys and Questionnaires
  • Spinal Fusion
  • Retrospective Studies
  • Recovery of Function
  • Prospective Studies
  • Postoperative Care
  • Orthopedics
  • Middle Aged
 

Citation

APA
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Pierce, K. E., Passias, P. G., Alas, H., Brown, A. E., Bortz, C. A., Lafage, R., … International Spine Study Group (ISSG), . (2020). Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up. Spine (Phila Pa 1976), 45(7), E397–E405. https://doi.org/10.1097/BRS.0000000000003288
Pierce, Katherine E., Peter G. Passias, Haddy Alas, Avery E. Brown, Cole A. Bortz, Renaud Lafage, Virginie Lafage, et al. “Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up.Spine (Phila Pa 1976) 45, no. 7 (April 1, 2020): E397–405. https://doi.org/10.1097/BRS.0000000000003288.
Pierce KE, Passias PG, Alas H, Brown AE, Bortz CA, Lafage R, et al. Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up. Spine (Phila Pa 1976). 2020 Apr 1;45(7):E397–405.
Pierce, Katherine E., et al. “Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up.Spine (Phila Pa 1976), vol. 45, no. 7, Apr. 2020, pp. E397–405. Pubmed, doi:10.1097/BRS.0000000000003288.
Pierce KE, Passias PG, Alas H, Brown AE, Bortz CA, Lafage R, Lafage V, Ames C, Burton DC, Hart R, Hamilton K, Kelly M, Hostin R, Bess S, Klineberg E, Line B, Shaffrey C, Mummaneni P, Smith JS, Schwab FA, International Spine Study Group (ISSG). Does Patient Frailty Status Influence Recovery Following Spinal Fusion for Adult Spinal Deformity?: An Analysis of Patients With 3-Year Follow-up. Spine (Phila Pa 1976). 2020 Apr 1;45(7):E397–E405.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

April 1, 2020

Volume

45

Issue

7

Start / End Page

E397 / E405

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surveys and Questionnaires
  • Spinal Fusion
  • Retrospective Studies
  • Recovery of Function
  • Prospective Studies
  • Postoperative Care
  • Orthopedics
  • Middle Aged