Introduction: Limited tools exist to stratify perioperative risk in neurosurgical patients undergoing spinal procedures. We hypothesized that a modification of the Canadian Study of Health and Aging- Frailty Index constructed from standard demographic variables, can be predictive of postoperative morbidity and mortality
Methods: The 2006-2010 National Surgical Quality Improvement Project (NSQIP) file was accessed for the neurosurgical population undergoing spinal surgeries based on CPT codes and Surgeon specialty. 11 preoperative clinical NSQIP variables were matched to the original 71 CSHA-FI variables (changes in daily activities,delirium, hypertension,coronary artery,congestive heart failure, et al.). Increase in the modified Frailty Index (mFI) implies increased frailty. The outcomes assessed were 30-day occurrence of adverse events. These were then summarized in groups: any infection, wound related complication, Clavien IV complications(life-threatening requiring ICU admission), and mortality. Chi-square analysis and nominal logistic regression were performed in SPSS 20 (IBM, NY)
Results: We identified 18,294 patients undergoing spinal surgery. Postoperative morbidity and mortality displayed an increasing trend with increasing mFI. 8.1% of patients with mFI of zero had atleast one morbid complication compared to 24.3% patients with mFI of 0.27 or greater (p<0.001). mFI of zero was associated with a mortality rate of 0.1% compared to 2.3% for mFI of 0.27 or greater (p<0.001). Surgical site infections and Clavien 4 complications occurred in 1.7% and 0.8%, respectively, in patients with mFI of zero compared to 4.1% and 7.1% respectively in patients with mFI of 0.27 or greater (p<0.001 for both). Multivariate analysis showed that preoperative mFI and ASA 4 and 5 class had a significantly increased risk of leading to Clavien IV complications. However, mFI was more powerful at predicting Clavien IV complications and death than ASA
Conclusions: mFI, based on preoperatively identifiable patient variables, accurately assesses the risk of postoperative morbidity and mortality, providing an easy method to improve perioperative risk stratification
Patient Care: it will allow us a tool to identify poor surgical candidates and allow us to obtain better informed consent
Learning Objectives: By the conclusion of the session the participants discuss the need and importance of national databases that can be used for peri-operative risk assessment of neurosurgical patients.