Assessing mFI-5 as a predictor of 30-day readmission, reoperation, and morbidity following 3-column osteotomy as surgical intervention for adult spinal deformity Mitchell Lee Seitz 1Donald
1 Jr. ,
Adam
1 Strigenz ,
David Essig
1,2 MD ,
and Barbara Zucker School of Medicine at Hofstra/Northwell,
Background • Adult spinal deformity (ASD) is defined as a complex spectrum of spinal deformities in adults such as degenerative scoliosis, kyphosis, and iatrogenic deformity. • In ASD patients with severe and rigid curves, a 3column osteotomy (3-COS) is required to achieve adequate correction of the deformity1. • Frailty is an increasingly studied variable for preoperative risk stratification2. However, its predictive value complication in 3-COS in ASD patients is unclear. • Goal: evaluate the association of the 5-item modified Frailty Index (5i-mFI) with 30-day adverse outcomes including readmission, reoperation, and morbidity following 3-column osteotomy.
Hypothesis We predict that increasing frailty, indicated by higher mFI-5 scores (mFI-5 = 0, non-frail; mFI-5 = 1, frail; mFI-5 = 2-5, severely frail), will be significantly associated with 30-day adverse outcomes following 3-column osteotomy in ASD patients.
and Austen Katz
2 LIJ
2 MD
Forest Hills Hospital
Results/Conclusions
Methods/Results • The National Surgical Quality Improvement Program was queried for patients undergoing 3-column osteotomy for ASD. • Inclusion criteria: patients who underwent a 3-column osteotomy (CPTs 22206, 22207, 22208).
• Pearson chi-square test will be used to calculate rates of adverse outcomes between frailty groups. • Univariate and multivariate logistic regression will be used to determine unadjusted and adjusted odds ratios. Total (n=983)
• Important exclusion criteria: • patients with missing readmission data • operation performed by surgeons outside of orthopedics or neurosurgery • Outcomes of interest included readmission, reoperation, and morbidity. Morbidity was indicated by the presence of any post-operative complication. • Frailty scores were calculated using mFI-5 based on the presence of 5 risk factors Risk Factor Dependent functional health status before surgery
1
Diabetes Mellitus with oral agents or insulin
1
Hypertension requiring medications
1
History of severe chronic obstructive pulmonary disease 1 Congestive heart failure in the 30 days before surgery
1
Total
5
• Significant confounding variables will be controlled for in order to ensure a direct association between mFI-5 and adverse outcomes -- these include: age, BMI, blood transfusions, OR time, etc.
Age, mean (Std. Deviation)
60 (13.8)
Sex (female), number (%)
577 (59.4%)
BMI, mean (Std. Deviation)
29.6 (6.4)
mFI-5 Components Dependent Functional Health Status Before Surgery, number (%) Diabetes Mellitus with Oral Agents or Insulin, number (%) Hypertension Requiring Medication, number (%) History of Severe COPD, number (%)
52 (5.4%)
CHF in 30 Days Before Surgery, number (%)
3 (0.3%)
149 (15.3%) 555 (57.2%) 55 (5.7%)
Resources 1. Youssef J, Orndorff D, Patty C, Scott M, Price H, Hamlin L, et al. Current status of adult spinal deformity. Glob Spine J. 2013;3:51. 2. D.N. Segal, J.M. Wilson, C. Staley, K.W. Michael. The 5Item Modified Frailty Index is predictive of 30-day postoperative complications in patients undergoing kyphoplasty vertebral augmentation. World Neurosurg, 116 (2018), pp. e225-e231