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Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool

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Abstract

Purpose

To develop a simplified, modified frailty index for adult spinal deformity (ASD) patients dependent on objective clinical factors.

Methods

ASD patients with baseline (BL) and 2-year (2Y) follow-up were included. Factors with the largest R2 value derived from multivariate forward stepwise regression were including in the modified ASD-FI (clin-ASD-FI). Factors included in the clin-ASD-FI were regressed against mortality, extended length of hospital stay (LOS, > 8 days), revisions, major complications and weights for the clin-ASD-FI were calculated via Beta/Sullivan. Total clin-ASD-FI score was created with a score from 0 to 1. Linear regression correlated clin-ASD-FI with ASD-FI scores and published cutoffs for the ASD-FI were used to create the new frailty cutoffs: not frail (NF: < 0.11), frail (F: 0.11–0.21) and severely frail (SF: > 0.21). Binary logistic regression assessed odds of complication or reop for frail patients.

Results

Five hundred thirty-one ASD patients (59.5 yrs, 79.5% F) were included. The final model had a R2 of 0.681, and significant factors were: < 18.5 or > 30 BMI (weight: 0.0625 out of 1), cardiac disease (0.125), disability employment status (0.3125), diabetes mellitus (0.0625), hypertension (0.0625), osteoporosis (0.125), blood clot (0.1875), and bowel incontinence (0.0625). These factors calculated the score from 0 to 1, with a mean cohort score of 0.13 ± 0.14. Breakdown by clin-ASD-FI score: 51.8% NF, 28.1% F, 20.2% SF. Increasing frailty severity was associated with longer LOS (NF: 7.0, F: 8.3, SF: 9.2 days; P < 0.001). Frailty independently predicted occurrence of any complication (OR: 9.357 [2.20–39.76], P = 0.002) and reop (OR: 2.79 [0.662–11.72], P = 0.162).

Conclusions

Utilizing an existing ASD frailty index, we proposed a modified version eliminating the patient-reported components. This index is a true assessment of physiologic status, and represents a superior risk factor assessment compared to other tools for both primary and revision spinal deformity surgery as a result of its immutability with surgery, lack of subjectivity, and ease of use.

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Data availability

Data available upon reasonable request.

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Funding

The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations.

Author information

Authors and Affiliations

  1. Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NYU Langone Medical Center, Orthopaedic Hospital – NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA

    Peter G. Passias, Katherine E. Pierce, Jamshaid M. Mir & Oscar Krol

  2. Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA

    Renaud Lafage & Virginie Lafage

  3. Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, CO, USA

    Breton Line & Shay Bess

  4. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

    Juan S. Uribe

  5. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA

    Richard Hostin

  6. Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA

    Alan Daniels & Bassel G. Diebo

  7. Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA

    Robert Hart

  8. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA

    Douglas Burton

  9. Department of Neurosurgery, Duke University, Durham, NC, USA

    Christopher Shaffrey

  10. Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA

    Frank Schwab

  11. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA

    Christopher P. Ames

  12. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Justin S. Smith

  13. Department of Orthopedic Surgery, Brigham and Women’s Center for Surgery and Public Health, Boston, MA, USA

    Andrew J. Schoenfeld

  14. Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA

    Eric O. Klineberg

Authors
  1. Peter G. Passias
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  2. Katherine E. Pierce
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  3. Jamshaid M. Mir
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  4. Oscar Krol
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  5. Renaud Lafage
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  6. Virginie Lafage
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  7. Breton Line
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  8. Juan S. Uribe
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  9. Richard Hostin
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  10. Alan Daniels
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  11. Robert Hart
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  12. Douglas Burton
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  13. Christopher Shaffrey
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  14. Frank Schwab
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  15. Bassel G. Diebo
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  16. Christopher P. Ames
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  17. Justin S. Smith
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  18. Andrew J. Schoenfeld
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  19. Shay Bess
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  20. Eric O. Klineberg
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Consortia

on behalf of the International Spine Study Group

Contributions

PGP, KEP, JMM, OK, RL, VL, BL, JSU, RH, AD, RH, DB, CS, FS, BGD, CPA, JSS, AJS, SB, EOK: Active involvement in drafting and critical revision of manuscript. PGP, KEP, JMM, OK, RL, VL, BL, JSU, RH, AD, RH, DB, CS, FS, BGD, CPA, JSS, AJS, SB, EOK: Provided final approval of version to be published. PGP, KEP, JMM, OK, RL, VL, BL, JSU, RH, AD, RH, DB, CS, FS, BGD, CPA, JSS, AJS, SB, EOK: Study Design. PGP, KEP, JMM, OK, RL, VL, BL, JSU, RH, AD, RH, DB, CS, FS, BGD, CPA, JSS, AJS, SB, EOK: Data Acquisition. PGP, KEP, JMM, OK, RL, VL, BL, JSU, RH, AD, RH, DB, CS, FS, BGD, CPA, JSS, AJS, SB, EOK; Analysis and interpretation of data.

Corresponding author

Correspondence to Peter G. Passias.

Ethics declarations

Conflict of interest

Peter G. Passias: Cerapedics: Other financial or material support. Cervical Scoliosis Research Society: Research support. Globus Medical: Paid presenter or speaker. Medtronic: Paid consultant. Royal Biologics: Paid consultant. Spine: Editorial or governing board. Spinevision: Other financial or material support. SpineWave: Paid consultant. Terumo: Paid consultant.

Ethical approval

Institutional Review Board was waived, as this study uses a de-identified nationwide database.

Informed consent

Informed consent was obtained prior to patient enrollment in database.

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Passias, P.G., Pierce, K.E., Mir, J.M. et al. Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool. Spine Deform 12, 811–817 (2024). https://doi.org/10.1007/s43390-023-00808-5

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  • DOI: https://doi.org/10.1007/s43390-023-00808-5

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