Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery.

Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery.

World Neurosurg. 2018 Jan 19;:

Authors: Reid DBC, Daniels AH, Ailon T, Miller E, Sciubba DM, Smith JS, Shaffrey CI, Schwab F, Burton D, Hart RA, Hostin R, Line B, Bess S, Ames CP, ISSG

Abstract
BACKGROUND: While the Adult Spinal Deformity Frailty Index (ASD-FI) predicts major complications and prolonged hospital length of stay after Adult Spinal Deformity (ASD) surgery, the impact of frailty on postoperative changes in health related quality of life (HRQoL) is unknown.
METHODS: Patients who underwent a ≥ 4 level instrumented fusion for ASD with minimum 2-year follow-up were stratified by ASD-FI score into 3 groups: not frail (NF); frail (F); and severely frail (SF). Baseline and follow-up demographics, HRQoL measures, and radiographic parameters were analyzed. Primary outcome measures included the proportion of patients who reached substantial clinical benefit (SCB) in terms of Oswestry Disability Index (ODI) score, SF-36 Physical Composite Score (PCS) score, and numeric back and leg pain scores.
RESULTS: 332 patients met inclusion criteria (135 NF, 175 F, 22 SF). F and SF patients were older and had more comorbidities, worse baseline HRQoL and pain scores, and worse radiographic deformity than NF patients (p<0.05). At 2-year follow-up, all outcome scores were worse in F and SF than NF patients. F patients, however, improved more than NF patients and were more likely to reach SCB for ODI (43.7% vs. 29.3%; p=0.025), PCS (56.9% vs 51.2%; p=0.03), and leg pain (45.8% vs 23.0%; p=0.03), but not back pain (57.5% vs 63.4%; p=0.045).
CONCLUSIONS: Despite higher risk stratification and worse baseline HRQoL, frail patients were more likely to reach SCB for most HRQoL measures compared to non-frail patients. Severely frail patients were the least likely to reach SCB for most HRQoL measures.

PMID: 29360585 [PubMed - as supplied by publisher]

http://ift.tt/2DBgEC7