Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery
Tóm tắt
Limited tools exist to stratify perioperative risk in patients undergoing spinal procedures. The modified frailty index (mFI) based on the Canadian Study of Health and Aging Frailty Index (CSHA-FI), constructed from standard demographic variables, has been applied to various other surgical populations for risk stratification. The authors hypothesized that it would be predictive of postoperative morbidity and mortality in patients undergoing spine surgery.
The 2006–2010 National Surgical Quality Improvement Program (NSQIP) data set was accessed for patients undergoing spine surgeries based on Current Procedural Terminology (CPT) codes. Sixteen preoperative clinical NSQIP variables were matched to 11 CSHA-FI variables (changes in daily activities, gastrointestinal problems, respiratory problems, clouding or delirium, hypertension, coronary artery and peripheral vascular disease, congestive heart failure, and so on). The outcomes assessed were 30-day occurrences of adverse events. These were then summarized in groups: any infection, wound-related complication, Clavien IV complications (life-threatening, requiring ICU admission), and mortality.
A total of 18,294 patients were identified. In 8.1% of patients with an mFI of 0 there was at least one morbid complication, compared with 24.3% of patients with an mFI of ≥ 0.27 (p < 0.001). An mFI of 0 was associated with a mortality rate of 0.1%, compared with 2.3% for an mFI of ≥ 0.27 (p < 0.001). Patients with an mFI of 0 had a 1.7% rate of surgical site infections and a 0.8% rate of Clavien IV complications, whereas patients with an mFI of ≥ 0.27 had rates of 4.1% and 7.1% for surgical site infections and Clavien IV complications, respectively (p < 0.001 for both). Multivariate analysis showed that the preoperative mFI and American Society of Anesthesiologists classification of ≥ III had a significantly increased risk of leading to Clavien IV complications and death.
A higher mFI was associated with a higher risk of postoperative morbidity and mortality, providing an additional tool to improve perioperative risk stratification.
Từ khóa
Tài liệu tham khảo
Atlas, 2005, Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine Lumbar Spine Study, 30, 936, 10.1097/01.brs.0000158953.57966.c0
Chaichana, 2009, Outcome following decompressive surgery for different histological types of metastatic tumors causing epidural spinal cord compression, 11, 56, 10.3171/2009.1.SPINE08657
Davis, 2007, Assessment of the reliability of data collected for the Department of Veterans Affairs national surgical quality improvement program, 204, 550, 10.1016/j.jamcollsurg.2007.01.012
Farhat, 2012, Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly, 72, 1526, 10.1097/TA.0b013e3182542fab
Fineberg, 2013, Incidence and mortality of perioperative cardiac events in cervical spine surgery, 38, 1268, 10.1097/BRS.0b013e318290fdac
Fu, 2011, Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery, 14, 470, 10.3171/2010.12.SPINE10486
Karam, 2013, Simplified frailty index to predict adverse outcomes and mortality in vascular surgery patients, 27, 904, 10.1016/j.avsg.2012.09.015
Kulminski, 2008, Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study, 56, 898, 10.1111/j.1532-5415.2008.01656.x
Lee, 2010, Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery, 121, 973, 10.1161/CIRCULATIONAHA.108.841437
Leung, 2011, Brief report: preoperative frailty in older surgical patients is associated with early postoperative delirium, 112, 1199, 10.1213/ANE.0b013e31820c7c06
Makary, 2010, Frailty as a predictor of surgical outcomes in older patients, 210, 901, 10.1016/j.jamcollsurg.2010.01.028
Martin, 2013, Hospital and surgeon variation in complications and repeat surgery following incident lumbar fusion for common degenerative diagnoses, 48, 1, 10.1111/j.1475-6773.2012.01434.x
Ma, 2010, Comparative in-hospital morbidity and mortality after revision versus primary thoracic and lumbar spine fusion, 10, 881, 10.1016/j.spinee.2010.07.391
Obeid, 2012, Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches, 72, 878, 10.1097/TA.0b013e31824d0f70
Robinson, 2009, Redefining geriatric preoperative assessment using frailty, disability and co-morbidity, 250, 449, 10.1097/SLA.0b013e3181b45598
Rockwood, 2007, A comparison of two approaches to measuring frailty in elderly people, 62, 738, 10.1093/gerona/62.7.738
Rubinfeld, 2010, Predicting surgical risk: how much data is enough?, 2010, 777
Shiloach, 2010, Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program, 210, 6, 10.1016/j.jamcollsurg.2009.09.031
Tsiouris, 2013, A modified frailty index to assess morbidity and mortality after lobectomy, 183, 40, 10.1016/j.jss.2012.11.059
Urrutia, 2012, Can the Surgical Apgar Score predict morbidity and mortality in general orthopaedic surgery?, 36, 2571, 10.1007/s00264-012-1696-1
Velanovich, 2013, Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database, 183, 104, 10.1016/j.jss.2013.01.021