Article
Frailty predicts adverse events in patients undergoing primary elective surgery for degenerative cervical spine disease
Der Frailty-Index zur Vorhersage von “adverse events” bei Patienten mit primärer, elektiver operativer Versorgung der degenerativen Halswirbelsäulenerkrankung
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Published: | May 25, 2022 |
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Objective: Preoperative risk/benefit assessment is essential, especially in non-complex primary elective surgery for degenerative cervical spine disease (DCSD). We therefore sought to determine the impact of frailty and preexisting comorbid disease burden on postoperative adverse events in this patient population.
Methods: Between 2013 and 2019 patients with DCSD who underwent elective surgery at our institution were included for further analysis. Information including patient characteristics, frailty and CCI were prospectively collected in a computerized database. Patients frailty was analyzed using the modified frailty index (mFI) and the Charlson comorbidity index (CCI) was used to assess the patients comorbidity burden. Postoperative complications were defined as adverse events (AE) that occurred within 30 days of surgery and were evaluated according to the Clavien-Dindo grading system (CDG).
Results: In total, 400 patients with DCSD and elective surgery were identified. Among patients categorized as “least-frail”, 4% suffered a postoperative AE, whereas 52% of “frailest” patients. Patients with age-adjusted CCI > 4 were significantly more likely to suffer postoperative complications (p<0.0001, OR 14.8, 95% 7.4-29.6). Multivariate analysis identified “age-adjusted CCI” (p=0.0001), “surgical invasiveness index >5” (p=0.03) and “frailest patient (mFI≥0.27)” (p<0.0001) as significant and independent predictors for the incidence of postoperative AE.
Conclusion: Our present study concludes that both increased frailty and comorbidity burden are significantly associated with higher rates of adverse events. The mFI may identify patients at higher risk for morbidity and mortality after elective surgery for degenerative cervical spine disease and it should become an essential component of risk stratification in this aging patient population.