Is frailty responsive to surgical correction of adult spinal deformity? An investigation of sagittal re-alignment and frailty component drivers of postoperative frailty status.

dc.contributor.author

Passias, Peter G

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Segreto, Frank A

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Moattari, Kevin A

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Lafage, Renaud

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Smith, Justin S

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Line, Breton G

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Eastlack, Robert K

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Burton, Douglas C

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Hart, Robert A

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Bess, Shay

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Shaffrey, Christopher I

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Ames, Christopher P

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Lafage, Virginie

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International Spine Study Group

dc.date.accessioned

2023-06-15T17:25:40Z

dc.date.available

2023-06-15T17:25:40Z

dc.date.issued

2022-07

dc.date.updated

2023-06-15T17:25:39Z

dc.description.abstract

Purpose

Frailty has been associated with adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity was developed. Components of the ASD-FI utilize patient comorbidity, clinical symptoms, and patient-reported-outcome-measures (PROMS). Our purpose was to investigate components of the Adult Spinal Deformity Frailty Index (ASD-FI) responsive to surgery and drivers of overall frailty.

Methods

Operative ASD patients ≥ 18 years, undergoing multilevel fusions, with complete baseline, 6 W, 1Y and 2Y ASD-FI scores. Descriptive analysis assessed demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t tests assessed postoperative changes to ASD-FI components, total score, and radiographic parameters. Linear regression models determined the effect of successful surgery (achieving lowest level SRS-Schwab classification modifiers) on change in ASD-FI total scores.

Results

409 6-week, 696 1-year, and 253 2-year operative ASD patients were included. 6-week and 1-year baseline frailty scores were 0.34, 2 years was 0.38. Following surgery, 6-week frailty was 0.36 (p = 0.033), 1 year was 0.25 (p < 0.001), and 2 years was 0.28 (p < 0.001). Of the ASD-FI variables, 17/40 improved at 6 weeks, 21/40 at 1 year, and 18/40 at 2 years. Successful surgery significantly predicted decreases in 1-year frailty scores (R = 0.27, p < 0.001), SRS-Schwab SVA modifier was the greatest predictor (Adjusted Beta: - 0.29, p < 0.001).

Conclusions

Improvement in sagittal realignment and functional status correlated with improved postoperative frailty. Additional research and deformity sub-group analyses are needed to describe associations between specific functional activities that correlated with frailty improvement as well as evaluation of modifiable and non-modifiable indices.

Level of evidence: 3

dc.identifier

10.1007/s43390-022-00476-x

dc.identifier.issn

2212-134X

dc.identifier.issn

2212-1358

dc.identifier.uri

https://hdl.handle.net/10161/28008

dc.language

eng

dc.publisher

Springer Science and Business Media LLC

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Spine deformity

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10.1007/s43390-022-00476-x

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International Spine Study Group

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Humans

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Treatment Outcome

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Retrospective Studies

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Follow-Up Studies

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Quality of Life

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Adult

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Frailty

dc.title

Is frailty responsive to surgical correction of adult spinal deformity? An investigation of sagittal re-alignment and frailty component drivers of postoperative frailty status.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

901

pubs.end-page

911

pubs.issue

4

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Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

10

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