A Risk-Benefit Analysis of Increasing Surgical Invasiveness Relative to Frailty Status in Adult Spinal Deformity Surgery.

dc.contributor.author

Passias, Peter G

dc.contributor.author

Brown, Avery E

dc.contributor.author

Bortz, Cole

dc.contributor.author

Pierce, Katherine

dc.contributor.author

Alas, Haddy

dc.contributor.author

Ahmad, Waleed

dc.contributor.author

Passfall, Lara

dc.contributor.author

Kummer, Nicholas

dc.contributor.author

Krol, Oscar

dc.contributor.author

Lafage, Renaud

dc.contributor.author

Lafage, Virginie

dc.contributor.author

Burton, Douglas

dc.contributor.author

Hart, Robert

dc.contributor.author

Anand, Neel

dc.contributor.author

Mundis, Gregory

dc.contributor.author

Neuman, Brian

dc.contributor.author

Line, Breton

dc.contributor.author

Shaffrey, Christopher

dc.contributor.author

Klineberg, Eric

dc.contributor.author

Smith, Justin

dc.contributor.author

Ames, Christopher

dc.contributor.author

Schwab, Frank J

dc.contributor.author

Bess, Shay

dc.contributor.author

International Spine Study Group

dc.date.accessioned

2023-06-16T16:34:02Z

dc.date.available

2023-06-16T16:34:02Z

dc.date.issued

2021-08

dc.date.updated

2023-06-16T16:34:01Z

dc.description.abstract

Study design

Retrospective review of a prospectively enrolled multicenter Adult Spinal Deformity (ASD) database.

Objective

Investigate invasiveness and outcomes of ASD surgery by frailty state.

Summary of background data

The ASD Invasiveness Index incorporates deformity-specific components to assess correction magnitude. Intersections of invasiveness, surgical outcomes, and frailty state are understudied.

Methods

ASD patients with baseline and 3-year (3Y) data were included. Logistic regression analyzed the relationship between increasing invasiveness and major complications or reoperations and meeting minimal clinically important differences (MCID) for health-related quality-of-life measures at 3Y. Decision tree analysis assessed invasiveness risk-benefit cutoff points, above which experiencing complications or reoperations and not reaching MCID were higher. Significance was set to P < 0.05.

Results

Overall, 195 of 322 patients were included. Baseline demographics: age 59.9 ± 14.4, 75% female, BMI 27.8 ± 6.2, mean Charlson Comorbidity Index: 1.7 ± 1.7. Surgical information: 61% osteotomy, 52% decompression, 11.0 ± 4.1 levels fused. There were 98 not frail (NF), 65 frail (F), and 30 severely frail (SF) patients. Relationships were found between increasing invasiveness and experiencing a major complication or reoperation for the entire cohort and by frailty group (all P < 0.05). Defining a favorable outcome as no major complications or reoperation and meeting MCID in any health-related quality of life at 3Y established an invasiveness cutoff of 63.9. Patients below this threshold were 1.8[1.38-2.35] (P < 0.001) times more likely to achieve favorable outcome. For NF patients, the cutoff was 79.3 (2.11[1.39-3.20] (P < 0.001), 111 for F (2.62 [1.70-4.06] (P < 0.001), and 53.3 for SF (2.35[0.78-7.13] (P = 0.13).

Conclusion

Increasing invasiveness is associated with increased odds of major complications and reoperations. Risk-benefit cutoffs for successful outcomes were 79.3 for NF, 111 for F, and 53.3 for SF patients. Above these, increasing invasiveness has increasing risk of major complications or reoperations and not meeting MCID at 3Y.Level of Evidence: 3.
dc.identifier

00007632-900000000-93798

dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28081

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0000000000003977

dc.subject

International Spine Study Group

dc.subject

Humans

dc.subject

Postoperative Complications

dc.subject

Neurosurgical Procedures

dc.subject

Logistic Models

dc.subject

Retrospective Studies

dc.subject

Quality of Life

dc.subject

Adult

dc.subject

Aged

dc.subject

Middle Aged

dc.subject

Female

dc.subject

Male

dc.subject

Frailty

dc.title

A Risk-Benefit Analysis of Increasing Surgical Invasiveness Relative to Frailty Status in Adult Spinal Deformity Surgery.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

1087

pubs.end-page

1096

pubs.issue

16

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

46

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
A Risk-Benefit Analysis of Increasing Surgical Invasiveness Relative to Frailty Status in Adult Spinal Deformity Surgery..pdf
Size:
1.09 MB
Format:
Adobe Portable Document Format