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  • Development of a Modified Cervical Deformity Frailty Index: A Streamlined Clinical Tool for Preoperative Risk Stratification

    Final Number:

    Peter G Passias MD; Cole Bortz BA; Frank Segreto; Renaud Lafage; Virginie Lafage PhD; Justin S. Smith MD PhD; Breton G. Line BSME; Muhammad Burhan Ud Din Janjua; Han Jo Kim MD; Robert Eastlack MD; D. Kojo Hamilton MD; Themistocles Protopsaltis MD; Richard A. Hostin MD; Eric Klineberg MD; Douglas C. Burton MD; Robert A. Hart; Frank Schwab; Shay Bess MD; Christopher I. Shaffrey MD, FACS; Christopher P. Ames MD; International Spine Study Group (ISSG)

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: To improve preoperative risk stratification for surgical cervical deformity (CD) patients, a CD frailty index (CD-FI) incorporating 40 factors was recently developed. To increase clinical utility, a simpler CD-FI (mCD-FI) is necessary.

    Methods: CD patients>18yr with preop CD-FI component factors. Bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R2 were dichotomized, and mean score of all deficits calculated, resulting in mCD-FI score from 0-1. Patients were stratified by published cutoffs: not frail(NF, <0.3), frail(0.3-0.5), severely frail(SF, >0.5). Means comparison tests established correlations between frailty category and clinical outcomes.

    Results: Included: 121 CD patients(61±11yrs, 60%F). The final multiple stepwise regression model identified the following factors as responsible for 86% of the variation in CD-FI score: lung disease(ß=0.033), BMI <18.5 or >30(ß=0.015), diabetes(ß=0.040), depression(ß=0.020), liver disease(ß=-1.101), rheumatoid arthritis(ß=0.058), venous disease(ß=0.099), unsteady gait(ß=0.022), bladder incontinence(ß=0.031), bowel incontinence(ß=0.044), leg weakness(ß=0.040), >3 comorbidities(ß=0.151), anxiety(ß=0.098), difficulty sleeping >6 hrs(ß=0.056), and inability to walk(ß=0.043). From these deficits, the overall population’s mCD-FI was calculated: 0.31±0.14. Patient breakdown by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. As compared to NF and frail patients, SF patients had the longest inpatient hospital stays(2.5 and 1.7 times longer, respectively,P=0.042), greater baseline neck pain (NRS Neck 1.3 and 1.1 times higher,P=0.033), inferior NDI scores(1.6 and 1.2 times greater,P<0.001) and inferior EQ-5D outcomes(1.2 and 1.1 times lower,P<0.001). Compared to NF, frail patients had higher odds of superficial infection(OR:1.1[1.001-1.2]), and SF patients had increased odds of mortality(OR:10.4[1.2-90.6]).

    Conclusions: This modified CD frailty index shows greater levels of patient frailty correlating with increased LOS, neck pain, and inferior clinical outcomes. The few number of deficits needed to calculate the present frailty score gives this modified CD frailty index increased clinical utility.

    Patient Care: The relatively few number of deficits needed to calculate the present frailty score gives this modified cervical deformity frailty index increased clinical utility, allowing for better preoperative risk stratification.

    Learning Objectives: By the conclusion of this session, participants should be able to understand flaws a simplified set of 15 factors contributing to patient frailty.


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