Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity

Mitsuru Yagi, Takehiro Michikawa, Naobumi Hosogane, Nobuyuki Fujita, Eijiro Okada, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Takashi Asazuma, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, Kota Watanabe

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN: A retrospective multicenter database review of 240 consecutive patients at least 21 years of age (mean 58 ± 17, range 22-79) who underwent surgery for adult spinal deformity (ASD) and were followed at least 2 years. OBJECTIVE: To investigate how treatment for frailty affects complications in surgery for ASD. SUMMARY OF BACKGROUND DATA: Several recent studies have focused on associations between frailty and surgical complications. However, it is not clear whether treating frailty affects complication rates in surgery for ASD. METHODS: Patients were categorized as robust (R group), prefrail, or frail based on the modified frailty index (mFI); prefrail and frail patients were divided by good control of frailty (G group), defined as treatment following the appropriate guidelines for each mFI factor, or poorly controlled frailty (PC group). We compared clinical outcomes and perioperative and 2-year complications between the three groups. RESULTS: Of the 240 patients, 142 (59%) were robust, 81 (34%) were prefrail, and 17 (7%) were frail. Among the frail and prefrail patients, 71 (72%) were classified as G and 27 (28%) as PC. The perioperative complication rate was similar in the G and PC groups (32% vs. 37%) but was significantly lower in the R group (15%, P < 0.01). The age- and sex-adjusted odds ratio for 2-year complications was not different in the P group when the G group was referenced (odds ratio 1.3 [0.5-3.2], P = 0.63). In the G and PC groups, which had similar 2-year outcomes, the Scoliosis Research Society-22 function and total scores were significantly lower than in the R group (function: R 3.9 ± 0.7, G 3.5 ± 0.7, P 3.3 ± 0.6; total: R 3.9 ± 0.6, 3.7 ± 0.7, 3.4 ± 0.6; P < 0.01). CONCLUSION: Regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.4.

Original languageEnglish
Pages (from-to)723-731
Number of pages9
JournalSpine
Volume44
Issue number10
DOIs
Publication statusPublished - 15-05-2019

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Therapeutics
Odds Ratio
Scoliosis
Outcome Assessment (Health Care)
Databases
Guidelines
Surgeons

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Yagi, M., Michikawa, T., Hosogane, N., Fujita, N., Okada, E., Suzuki, S., ... Watanabe, K. (2019). Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity. Spine, 44(10), 723-731. https://doi.org/10.1097/BRS.0000000000002929
Yagi, Mitsuru ; Michikawa, Takehiro ; Hosogane, Naobumi ; Fujita, Nobuyuki ; Okada, Eijiro ; Suzuki, Satoshi ; Tsuji, Osahiko ; Nagoshi, Narihito ; Asazuma, Takashi ; Tsuji, Takashi ; Nakamura, Masaya ; Matsumoto, Morio ; Watanabe, Kota. / Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity. In: Spine. 2019 ; Vol. 44, No. 10. pp. 723-731.
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abstract = "STUDY DESIGN: A retrospective multicenter database review of 240 consecutive patients at least 21 years of age (mean 58 ± 17, range 22-79) who underwent surgery for adult spinal deformity (ASD) and were followed at least 2 years. OBJECTIVE: To investigate how treatment for frailty affects complications in surgery for ASD. SUMMARY OF BACKGROUND DATA: Several recent studies have focused on associations between frailty and surgical complications. However, it is not clear whether treating frailty affects complication rates in surgery for ASD. METHODS: Patients were categorized as robust (R group), prefrail, or frail based on the modified frailty index (mFI); prefrail and frail patients were divided by good control of frailty (G group), defined as treatment following the appropriate guidelines for each mFI factor, or poorly controlled frailty (PC group). We compared clinical outcomes and perioperative and 2-year complications between the three groups. RESULTS: Of the 240 patients, 142 (59{\%}) were robust, 81 (34{\%}) were prefrail, and 17 (7{\%}) were frail. Among the frail and prefrail patients, 71 (72{\%}) were classified as G and 27 (28{\%}) as PC. The perioperative complication rate was similar in the G and PC groups (32{\%} vs. 37{\%}) but was significantly lower in the R group (15{\%}, P < 0.01). The age- and sex-adjusted odds ratio for 2-year complications was not different in the P group when the G group was referenced (odds ratio 1.3 [0.5-3.2], P = 0.63). In the G and PC groups, which had similar 2-year outcomes, the Scoliosis Research Society-22 function and total scores were significantly lower than in the R group (function: R 3.9 ± 0.7, G 3.5 ± 0.7, P 3.3 ± 0.6; total: R 3.9 ± 0.6, 3.7 ± 0.7, 3.4 ± 0.6; P < 0.01). CONCLUSION: Regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.4.",
author = "Mitsuru Yagi and Takehiro Michikawa and Naobumi Hosogane and Nobuyuki Fujita and Eijiro Okada and Satoshi Suzuki and Osahiko Tsuji and Narihito Nagoshi and Takashi Asazuma and Takashi Tsuji and Masaya Nakamura and Morio Matsumoto and Kota Watanabe",
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Yagi, M, Michikawa, T, Hosogane, N, Fujita, N, Okada, E, Suzuki, S, Tsuji, O, Nagoshi, N, Asazuma, T, Tsuji, T, Nakamura, M, Matsumoto, M & Watanabe, K 2019, 'Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity', Spine, vol. 44, no. 10, pp. 723-731. https://doi.org/10.1097/BRS.0000000000002929

Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity. / Yagi, Mitsuru; Michikawa, Takehiro; Hosogane, Naobumi; Fujita, Nobuyuki; Okada, Eijiro; Suzuki, Satoshi; Tsuji, Osahiko; Nagoshi, Narihito; Asazuma, Takashi; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota.

In: Spine, Vol. 44, No. 10, 15.05.2019, p. 723-731.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity

AU - Yagi, Mitsuru

AU - Michikawa, Takehiro

AU - Hosogane, Naobumi

AU - Fujita, Nobuyuki

AU - Okada, Eijiro

AU - Suzuki, Satoshi

AU - Tsuji, Osahiko

AU - Nagoshi, Narihito

AU - Asazuma, Takashi

AU - Tsuji, Takashi

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Watanabe, Kota

PY - 2019/5/15

Y1 - 2019/5/15

N2 - STUDY DESIGN: A retrospective multicenter database review of 240 consecutive patients at least 21 years of age (mean 58 ± 17, range 22-79) who underwent surgery for adult spinal deformity (ASD) and were followed at least 2 years. OBJECTIVE: To investigate how treatment for frailty affects complications in surgery for ASD. SUMMARY OF BACKGROUND DATA: Several recent studies have focused on associations between frailty and surgical complications. However, it is not clear whether treating frailty affects complication rates in surgery for ASD. METHODS: Patients were categorized as robust (R group), prefrail, or frail based on the modified frailty index (mFI); prefrail and frail patients were divided by good control of frailty (G group), defined as treatment following the appropriate guidelines for each mFI factor, or poorly controlled frailty (PC group). We compared clinical outcomes and perioperative and 2-year complications between the three groups. RESULTS: Of the 240 patients, 142 (59%) were robust, 81 (34%) were prefrail, and 17 (7%) were frail. Among the frail and prefrail patients, 71 (72%) were classified as G and 27 (28%) as PC. The perioperative complication rate was similar in the G and PC groups (32% vs. 37%) but was significantly lower in the R group (15%, P < 0.01). The age- and sex-adjusted odds ratio for 2-year complications was not different in the P group when the G group was referenced (odds ratio 1.3 [0.5-3.2], P = 0.63). In the G and PC groups, which had similar 2-year outcomes, the Scoliosis Research Society-22 function and total scores were significantly lower than in the R group (function: R 3.9 ± 0.7, G 3.5 ± 0.7, P 3.3 ± 0.6; total: R 3.9 ± 0.6, 3.7 ± 0.7, 3.4 ± 0.6; P < 0.01). CONCLUSION: Regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.4.

AB - STUDY DESIGN: A retrospective multicenter database review of 240 consecutive patients at least 21 years of age (mean 58 ± 17, range 22-79) who underwent surgery for adult spinal deformity (ASD) and were followed at least 2 years. OBJECTIVE: To investigate how treatment for frailty affects complications in surgery for ASD. SUMMARY OF BACKGROUND DATA: Several recent studies have focused on associations between frailty and surgical complications. However, it is not clear whether treating frailty affects complication rates in surgery for ASD. METHODS: Patients were categorized as robust (R group), prefrail, or frail based on the modified frailty index (mFI); prefrail and frail patients were divided by good control of frailty (G group), defined as treatment following the appropriate guidelines for each mFI factor, or poorly controlled frailty (PC group). We compared clinical outcomes and perioperative and 2-year complications between the three groups. RESULTS: Of the 240 patients, 142 (59%) were robust, 81 (34%) were prefrail, and 17 (7%) were frail. Among the frail and prefrail patients, 71 (72%) were classified as G and 27 (28%) as PC. The perioperative complication rate was similar in the G and PC groups (32% vs. 37%) but was significantly lower in the R group (15%, P < 0.01). The age- and sex-adjusted odds ratio for 2-year complications was not different in the P group when the G group was referenced (odds ratio 1.3 [0.5-3.2], P = 0.63). In the G and PC groups, which had similar 2-year outcomes, the Scoliosis Research Society-22 function and total scores were significantly lower than in the R group (function: R 3.9 ± 0.7, G 3.5 ± 0.7, P 3.3 ± 0.6; total: R 3.9 ± 0.6, 3.7 ± 0.7, 3.4 ± 0.6; P < 0.01). CONCLUSION: Regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.4.

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