Baseline Frailty Status Influences Recovery Patterns and Outcomes Following Alignment Correction of Cervical Deformity.

dc.contributor.author

Pierce, Katherine E

dc.contributor.author

Passias, Peter G

dc.contributor.author

Daniels, Alan H

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Lafage, Renaud

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Ahmad, Waleed

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Naessig, Sara

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Lafage, Virginie

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Protopsaltis, Themistocles

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Eastlack, Robert

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Hart, Robert

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Burton, Douglas

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Bess, Shay

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Schwab, Frank

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Shaffrey, Christopher

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Smith, Justin S

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Ames, Christopher

dc.date.accessioned

2023-06-19T18:26:15Z

dc.date.available

2023-06-19T18:26:15Z

dc.date.issued

2021-05

dc.date.updated

2023-06-19T18:26:15Z

dc.description.abstract

Background

Frailty severity may be an important determinant for impaired recovery after cervical spine deformity (CD) corrective surgery.

Objective

To evaluate postop clinical recovery among CD patients between frailty states undergoing primary procedures.

Methods

Patients >18 yr old undergoing surgery for CD with health-related quality of life (HRQL) data at baseline, 3-mo, and 1-yr postoperative were identified. Patients were stratified by the modified CD frailty index scale from 0 to 1 (no frailty [NF] <0.3, mild/severe fraily [F] >0.3). Patients in NF and F groups were propensity score matched for TS-CL (T1 slope [TS] minus angle between the C2 inferior end plate and the C7 inferior end plate [CL]) to control for baseline deformity. Area under the curve was calculated for follow-up time intervals determining overall normalized, time-adjusted HRQL outcomes; Integrated Health State (IHS) was compared between NF and F groups.

Results

A total of 106 CD patients were included (61.7 yr, 66% F, 27.7 kg/m2)-by frailty group: 52.8% NF, 47.2% F. After propensity score matching for TS-CL (mean: 38.1°), 38 patients remained in each of the NF and F groups. IHS-adjusted HRQL outcomes from baseline to 1 yr showed a significant difference in Euro-Qol 5 Dimension scores (NF: 1.02, F: 1.07, P = .016). No significant differences were found in the IHS Neck Disability Index (NDI) and modified Japanese Orthopedic Association between frailty groups (P > .05). F patients had more postop major complications (31.3%) compared to the NF (8.9%), P = .004, though DJK occurrence and reoperation between the groups was not significant.

Conclusion

While all groups exhibited improved postop disability and pain scores, frail patients experienced greater amount of improvement in overall health state compared to baseline disability. This signifies that with frailty severity, patients have more room for improvement postop compared to baseline quality of life.
dc.identifier

6145842

dc.identifier.issn

0148-396X

dc.identifier.issn

1524-4040

dc.identifier.uri

https://hdl.handle.net/10161/28101

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Neurosurgery

dc.relation.isversionof

10.1093/neuros/nyab039

dc.subject

Cervical Vertebrae

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Humans

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Spinal Cord Diseases

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Postoperative Period

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Reoperation

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Severity of Illness Index

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Retrospective Studies

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Recovery of Function

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Time Factors

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Quality of Life

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Adult

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Aged

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Middle Aged

dc.subject

Frailty

dc.title

Baseline Frailty Status Influences Recovery Patterns and Outcomes Following Alignment Correction of Cervical Deformity.

dc.type

Journal article

duke.contributor.orcid

Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

1121

pubs.end-page

1127

pubs.issue

6

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

88

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