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

International Spine Study Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

STUDY DESIGN: Retrospective review. OBJECTIVE: Develop a simplified frailty index for cervical deformity (CD) patients. SUMMARY OF BACKGROUND DATA: To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary. METHODS: CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: 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 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]). CONCLUSION: Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.3.

Original languageEnglish (US)
Pages (from-to)169-176
Number of pages8
JournalSpine
Volume44
Issue number3
DOIs
StatePublished - Feb 1 2019
Externally publishedYes

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Neck Pain
Length of Stay
Mortality
Infection
Inpatients
Neck
Quality of Life
Health

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Development of a Modified Cervical Deformity Frailty Index : A Streamlined Clinical Tool for Preoperative Risk Stratification. / International Spine Study Group.

In: Spine, Vol. 44, No. 3, 01.02.2019, p. 169-176.

Research output: Contribution to journalArticle

@article{06f4eca31a76403e894991652e3b71c6,
title = "Development of a Modified Cervical Deformity Frailty Index: A Streamlined Clinical Tool for Preoperative Risk Stratification",
abstract = "STUDY DESIGN: Retrospective review. OBJECTIVE: Develop a simplified frailty index for cervical deformity (CD) patients. SUMMARY OF BACKGROUND DATA: To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary. METHODS: CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: 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 ± 11 yr, 60{\%}F). Multiple stepwise regression models identified 15 deficits as responsible for 86{\%} of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9{\%}, Frail: 46.3{\%}, SF: 5.8{\%}. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]). CONCLUSION: Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.3.",
author = "{International Spine Study Group} and Passias, {Peter G.} and Bortz, {Cole A.} and Segreto, {Frank A.} and Horn, {Samantha R.} and Renaud Lafage and Virginie Lafage and Smith, {Justin S.} and Breton Line and Kim, {Han Jo} and Robert Eastlack and Hamilton, {David Kojo} and Themistocles Protopsaltis and Hostin, {Richard A.} and Klineberg, {Eric O.} and Burton, {Douglas C.} and Robert Hart and Schwab, {Frank J.} and Shay Bess and Shaffrey, {Christopher I.} and Ames, {Christopher P.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1097/BRS.0000000000002778",
language = "English (US)",
volume = "44",
pages = "169--176",
journal = "Spine",
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TY - JOUR

T1 - Development of a Modified Cervical Deformity Frailty Index

T2 - A Streamlined Clinical Tool for Preoperative Risk Stratification

AU - International Spine Study Group

AU - Passias, Peter G.

AU - Bortz, Cole A.

AU - Segreto, Frank A.

AU - Horn, Samantha R.

AU - Lafage, Renaud

AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Line, Breton

AU - Kim, Han Jo

AU - Eastlack, Robert

AU - Hamilton, David Kojo

AU - Protopsaltis, Themistocles

AU - Hostin, Richard A.

AU - Klineberg, Eric O.

AU - Burton, Douglas C.

AU - Hart, Robert

AU - Schwab, Frank J.

AU - Bess, Shay

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - STUDY DESIGN: Retrospective review. OBJECTIVE: Develop a simplified frailty index for cervical deformity (CD) patients. SUMMARY OF BACKGROUND DATA: To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary. METHODS: CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: 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 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]). CONCLUSION: Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.3.

AB - STUDY DESIGN: Retrospective review. OBJECTIVE: Develop a simplified frailty index for cervical deformity (CD) patients. SUMMARY OF BACKGROUND DATA: To improve preoperative risk stratification for surgical CD patients, a CD frailty index (CD-FI) incorporating 40 health deficits was developed. While novel, the CD-FI is clinically impractical due to the large number of factors needed for its calculation. To increase clinical utility, a simpler, modified CD-FI (mCD-FI) is necessary. METHODS: CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4 cm, or CBVA>25°) >18 year with preoperative CD-FI component factors. Pearson bivariate correlation assessed relationships between component deficits of the CD-FI and overall CD-FI score. Top deficits contributing to CD-FI score were included in multiple stepwise regression models. Deficits from model with largest R were dichotomized, and the mean score of all deficits calculated, resulting in mCD-FI score from 0 to 1. Patients were stratified by mCD-FI: 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 ± 11 yr, 60%F). Multiple stepwise regression models identified 15 deficits as responsible for 86% of the variation in CD-FI; these factors were used to construct the mCD-FI. Overall, mean mCD-FI was 0.31 ± 0.14. Breakdown of patients by mCD-FI category: NF: 47.9%, Frail: 46.3%, SF: 5.8%. Compared with NF and Frail, SF patients had the longest inpatient hospital stays (P = 0.042), as well as greater baseline neck pain (P = 0.033), inferior Neck Disability Index scores (P<0.001) and inferior EQ-5D scores (P < 0.001). Frail patients had higher odds of superficial infection (OR:1.1[1.0-1.2]), and SF patients had increased odds of mortality (OR:8.3[1.3-53.9]). CONCLUSION: Increased frailty, assessed by mCD-FI, correlated with increased length of stay, neck pain, and decreased health-related quality of life. Frail patients were at greater risk for infection, and severely frail patients had greater odds of mortality. This relationship between frailty and clinical outcomes suggests that mCD-FI offers clinical utility as a preoperative risk stratification tool.3.

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