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Frailty and Post-Operative Outcomes in the Older Patients Undergoing Elective Posterior Thoracolumbar Fusion Surgery

Authors Sun W, Lu S, Kong C, Li Z, Wang P, Zhang S

Received 9 January 2020

Accepted for publication 3 July 2020

Published 14 July 2020 Volume 2020:15 Pages 1141—1150


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Zhi-Ying Wu

Wenzhi Sun, Shibao Lu, Chao Kong, Zhongen Li, Peng Wang, Sitao Zhang

Department of Orthopaedics, Capital Medical University Xuanwu Hospital, Beijing 100053, People’s Republic of China

Correspondence: Shibao Lu Email [email protected]

Background and Aim: Frailty is an independent predictor of mortality and adverse events (AEs) in patients undergoing surgery. This study aimed to quantify the ability of Modified Frailty Index (mFI) to predict AEs in older patients undergoing elective posterior thoracolumbar fusion surgery.
Methods: We retrospectively reviewed the results of 426 patients with the following diagnoses and follow-up evaluations of at least 12 months duration: lumbar disc herniation, 125; degenerative spondylolisthesis, 81; lumbar spinal canal stenosis, 187; and adult spinal deformities, 33. The cases were divided into two groups. The long spinal fusion (LSF) group was defined as ≥ 3 spinal levels with segmental pedicle-screw fixation. Short spinal fusion (SSF) were defined with at most two levels. The mFI used in the present study is an 11-variable assessment. The association of frailty with AEs was determined after adjusting for known and suspected confounders.
Results: Frailty was presented in 66 patients (15.5%) within the total population (LSF, 21.9% and SSF, 11.8%). Rates of AEs assessed in the study increased stepwise with an increase in the mFI for the two groups. The severity of frailty was an independent predictor of any, major, and minor complications in the LSF group and any, minor complication in the SSF group (P< 0.05). A comparison of post-operative clinical outcomes showed that the ODI and SF-36 scores deteriorated as the mFI increased.
Conclusion: Frailty was shown to be an independent predictor of AEs in older patients undergoing elective posterior thoracolumbar fusion surgery, especially for patients undergoing LSF.

Keywords: frailty, degenerative spine disease, spinal surgery, elderly, clinical evaluation, complications, risk stratification

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