Introduction: Surgical treatment of patients with ASD is associated with substantial cost and complications. The aim of our study was to develop a FI based on preoperative measures of the patient physical condition that would correlate to common quality and value metrics.
Methods: Operatively treated ASD patients were identified, and intra-, peri-, and postoperative major complications were noted over a 2-yr F/U. Univariate logistic regression analyses were performed on 50% random sample to analyze the association between patient age, Oswestry Disability Index (ODI), Charlson comorbidity score (CCS), and comorbidities not included in the CCS such as hypertension, and between major complication development. Factors that were found to be significant were differentially weighted to construct FI, which was validated on the remaining 50% sample.
Results: Following variables were significantly associated with complications and were used to calculate FI: age (assigned 0/1/2 points), CCS (0/1/2 points), depression (0/1 point), osteoporosis (0/1 point), hypertension (0/1 point), and ODI (0/1/2 points). The rate of major complications increased significantly with FI (P<0.01); there was a 2.7-fold odds of developing major complications in patients with FI=3 vs. those FI=2 (32.0% vs. 14.7%). Patients with FI=3 also had significantly longer length of stay (P=0.002), and significantly worse baseline (P<0.001) and 2-yr F/U (P=0.009) SRS total scores, despite both groups achieving significant improvements in SRS total scores postoperatively (p<0.001). On logistic regression analysis, FI stratified major complications better than ASA or CCS alone.
Conclusions: In operatively treated ASD patients, FI=3 predicted greater complications, higher length of stay and worse self-reported outcomes before and after spinal surgery.
Patient Care: This research will improve patient care by proposing a novel metric, the FI, to measure the patient's physical condition. This will aid in treatment planning as well as patient counseling.
Learning Objectives: By the conclusion of this session participants should be able to: 1) understand the key components of the proposed FI, 2) understand that the FI predicts greater complications, higher LOS and worse outcomes, and 3) incorporate the FI into their practice to determine the frailty of their patients.