Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders

Mitsuru Yagi, Nobuyuki Fujita, Eijiro Okada, Osahiko Tsuji, Narihito Nagoshi, Takashi Tsuji, Takashi Asazuma, Masaya Nakamura, Morio Matsumoto, Kota Watanabe

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Study Design. Retrospective review of surgically treated 481 adult patients with spinal disorders. Objective. The aim of this study was to elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates. Summary of Background Data. Elective surgeries for spinal disorders not only improve clinical outcomes but also have high complication rates. Methods. We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformities (ASDs: 65-9 years), 152 degenerative spondylolisthesis (DS: 64-10 years), or 173 lumbar spinal canal stenosis (LSCS: 71-9 years) with follow-up of at least 2 years. Modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI) were determined from baseline demographics. We compared the prevalence and the influence of mFI and CCI on postoperative outcomes and complication rates. Results. The mFI and CCI were significantly worse in ASD than in others (mFI: ASD 0.09-0.12, DS 0.06-0.06, LSCS 0.04-0.05, P<0.01. CCI: ASD 2.1-1.6, DS 1.4-0.7, LSCS 1.6-0.9, P<0.01). Postoperative HRQoL deteriorated as mFI worsened in ASD (nofrail: Oswestry Disability Index [ODI] 26-11, Scoliosis Research Society Questionnaire [SRS] 3.7-0.7; prefrail: ODI 32-12, SRS 3.6-0.6; frail: ODI 42-15, SRS 3.2-0.7). In DS and LSCS, however, SF-36 physical component score and mental component score improved regardless of mFI and CCI. The 2-year major complications rate increased with frailty (36%, 58%, and 81%) in ASD, but not in others. Conclusion. ASDs were more frail and had more comorbidities than the other populations. In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailty and CCI. Careful patient selection and treatment of comorbidities before surgery may decrease complications and improve outcomes for the surgical treatment of ASD.

Original languageEnglish
Pages (from-to)1259-1267
Number of pages9
JournalSpine
Volume43
Issue number18
DOIs
Publication statusPublished - 01-01-2018

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Comorbidity
Scoliosis
Research
Quality of Life
Spondylolisthesis
Spinal Stenosis
Spinal Canal
Patient Selection
Spine
Demography
Population
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Yagi, Mitsuru ; Fujita, Nobuyuki ; Okada, Eijiro ; Tsuji, Osahiko ; Nagoshi, Narihito ; Tsuji, Takashi ; Asazuma, Takashi ; Nakamura, Masaya ; Matsumoto, Morio ; Watanabe, Kota. / Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders. In: Spine. 2018 ; Vol. 43, No. 18. pp. 1259-1267.
@article{0131c29744404674a07d2957c3fcebe1,
title = "Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders",
abstract = "Study Design. Retrospective review of surgically treated 481 adult patients with spinal disorders. Objective. The aim of this study was to elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates. Summary of Background Data. Elective surgeries for spinal disorders not only improve clinical outcomes but also have high complication rates. Methods. We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformities (ASDs: 65-9 years), 152 degenerative spondylolisthesis (DS: 64-10 years), or 173 lumbar spinal canal stenosis (LSCS: 71-9 years) with follow-up of at least 2 years. Modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI) were determined from baseline demographics. We compared the prevalence and the influence of mFI and CCI on postoperative outcomes and complication rates. Results. The mFI and CCI were significantly worse in ASD than in others (mFI: ASD 0.09-0.12, DS 0.06-0.06, LSCS 0.04-0.05, P<0.01. CCI: ASD 2.1-1.6, DS 1.4-0.7, LSCS 1.6-0.9, P<0.01). Postoperative HRQoL deteriorated as mFI worsened in ASD (nofrail: Oswestry Disability Index [ODI] 26-11, Scoliosis Research Society Questionnaire [SRS] 3.7-0.7; prefrail: ODI 32-12, SRS 3.6-0.6; frail: ODI 42-15, SRS 3.2-0.7). In DS and LSCS, however, SF-36 physical component score and mental component score improved regardless of mFI and CCI. The 2-year major complications rate increased with frailty (36{\%}, 58{\%}, and 81{\%}) in ASD, but not in others. Conclusion. ASDs were more frail and had more comorbidities than the other populations. In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailty and CCI. Careful patient selection and treatment of comorbidities before surgery may decrease complications and improve outcomes for the surgical treatment of ASD.",
author = "Mitsuru Yagi and Nobuyuki Fujita and Eijiro Okada and Osahiko Tsuji and Narihito Nagoshi and Takashi Tsuji and Takashi Asazuma and Masaya Nakamura and Morio Matsumoto and Kota Watanabe",
year = "2018",
month = "1",
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doi = "10.1097/BRS.0000000000002596",
language = "English",
volume = "43",
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Yagi, M, Fujita, N, Okada, E, Tsuji, O, Nagoshi, N, Tsuji, T, Asazuma, T, Nakamura, M, Matsumoto, M & Watanabe, K 2018, 'Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders', Spine, vol. 43, no. 18, pp. 1259-1267. https://doi.org/10.1097/BRS.0000000000002596

Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders. / Yagi, Mitsuru; Fujita, Nobuyuki; Okada, Eijiro; Tsuji, Osahiko; Nagoshi, Narihito; Tsuji, Takashi; Asazuma, Takashi; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota.

In: Spine, Vol. 43, No. 18, 01.01.2018, p. 1259-1267.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Impact of frailty and comorbidities on surgical outcomes and complications in adult spinal disorders

AU - Yagi, Mitsuru

AU - Fujita, Nobuyuki

AU - Okada, Eijiro

AU - Tsuji, Osahiko

AU - Nagoshi, Narihito

AU - Tsuji, Takashi

AU - Asazuma, Takashi

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Watanabe, Kota

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Study Design. Retrospective review of surgically treated 481 adult patients with spinal disorders. Objective. The aim of this study was to elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates. Summary of Background Data. Elective surgeries for spinal disorders not only improve clinical outcomes but also have high complication rates. Methods. We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformities (ASDs: 65-9 years), 152 degenerative spondylolisthesis (DS: 64-10 years), or 173 lumbar spinal canal stenosis (LSCS: 71-9 years) with follow-up of at least 2 years. Modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI) were determined from baseline demographics. We compared the prevalence and the influence of mFI and CCI on postoperative outcomes and complication rates. Results. The mFI and CCI were significantly worse in ASD than in others (mFI: ASD 0.09-0.12, DS 0.06-0.06, LSCS 0.04-0.05, P<0.01. CCI: ASD 2.1-1.6, DS 1.4-0.7, LSCS 1.6-0.9, P<0.01). Postoperative HRQoL deteriorated as mFI worsened in ASD (nofrail: Oswestry Disability Index [ODI] 26-11, Scoliosis Research Society Questionnaire [SRS] 3.7-0.7; prefrail: ODI 32-12, SRS 3.6-0.6; frail: ODI 42-15, SRS 3.2-0.7). In DS and LSCS, however, SF-36 physical component score and mental component score improved regardless of mFI and CCI. The 2-year major complications rate increased with frailty (36%, 58%, and 81%) in ASD, but not in others. Conclusion. ASDs were more frail and had more comorbidities than the other populations. In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailty and CCI. Careful patient selection and treatment of comorbidities before surgery may decrease complications and improve outcomes for the surgical treatment of ASD.

AB - Study Design. Retrospective review of surgically treated 481 adult patients with spinal disorders. Objective. The aim of this study was to elucidate the effect of frailty and comorbidities on postoperative health-related quality of life (HRQoL) and complication rates. Summary of Background Data. Elective surgeries for spinal disorders not only improve clinical outcomes but also have high complication rates. Methods. We retrospectively reviewed the results of consecutive elective spine surgeries for 156 adult spinal deformities (ASDs: 65-9 years), 152 degenerative spondylolisthesis (DS: 64-10 years), or 173 lumbar spinal canal stenosis (LSCS: 71-9 years) with follow-up of at least 2 years. Modified Frailty Index (mFI) and Charlson Comorbidity Index (CCI) were determined from baseline demographics. We compared the prevalence and the influence of mFI and CCI on postoperative outcomes and complication rates. Results. The mFI and CCI were significantly worse in ASD than in others (mFI: ASD 0.09-0.12, DS 0.06-0.06, LSCS 0.04-0.05, P<0.01. CCI: ASD 2.1-1.6, DS 1.4-0.7, LSCS 1.6-0.9, P<0.01). Postoperative HRQoL deteriorated as mFI worsened in ASD (nofrail: Oswestry Disability Index [ODI] 26-11, Scoliosis Research Society Questionnaire [SRS] 3.7-0.7; prefrail: ODI 32-12, SRS 3.6-0.6; frail: ODI 42-15, SRS 3.2-0.7). In DS and LSCS, however, SF-36 physical component score and mental component score improved regardless of mFI and CCI. The 2-year major complications rate increased with frailty (36%, 58%, and 81%) in ASD, but not in others. Conclusion. ASDs were more frail and had more comorbidities than the other populations. In ASD, postsurgical outcomes and complication rates deteriorated as frailty and CCI increased, whereas surgery produced favorable outcomes and acceptable complication rates in DS and LSCS regardless of frailty and CCI. Careful patient selection and treatment of comorbidities before surgery may decrease complications and improve outcomes for the surgical treatment of ASD.

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U2 - 10.1097/BRS.0000000000002596

DO - 10.1097/BRS.0000000000002596

M3 - Review article

C2 - 29481382

AN - SCOPUS:85059798073

VL - 43

SP - 1259

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JO - Spine

JF - Spine

SN - 0362-2436

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