BACKGROUND With an aging population, elderly patients with multiple comorbidities are more frequently undergoing spine surgery and may be at increased risk for complications. Objective measurement of frailty may predict the incidence of postoperative adverse events. OBJECTIVE To investigate the associations between preoperative frailty and postoperative spine surgery outcomes including mortality, length of stay, readmission, surgical site infection, and venous thromboembolic disease. METHODS As part of a system-wide quality improvement initiative, frailty assessment was added to the routine assessment of patients considering spine surgery beginning in July 2016. Frailty was assessed with the Risk Analysis Index (RAI), and patients were categorized as nonfrail (RAI 0-29) or prefrail/frail (RAI ≥ 30). Comparisons between nonfrail and prefrail/frail patients were analyzed using Fisher's exact test for categorical data or by Wilcoxon rank sum tests for continuous data. RESULTS From August 2016 through September 2018, 668 patients (age of 59.5 ± 13.3 yr) had a preoperative RAI score recorded and underwent scheduled spine surgery. Prefrail and frail patients suffered comparatively higher rates of mortality at 90 d (1.9% vs 0.2%, P < .05) and 1 yr (5.1% vs 1.2%, P < .01) from the procedure date. They also had longer in-hospital length of stay (LOS) (3.9 d ± 3.6 vs 3.1 d ± 2.8, P < .001) and higher rates of 60 d (14.6% vs 8.2%, P < .05) and 90 d (15.8% vs 9.8%, P < .05) readmissions. CONCLUSION Preoperative frailty, as measured by the RAI, was associated with an increased risk of readmission and 90-d and 1-yr mortality following spine surgery. The RAI can be used to stratify spine patients and inform preoperative surgical decision making.

中文翻译：

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脊柱手术后虚弱对结果的影响：668 名患者的前瞻性队列分析

背景随着人口老龄化，患有多种合并症的老年患者更频繁地接受脊柱手术，并且并发症的风险可能增加。虚弱的客观测量可以预测术后不良事件的发生率。目的 调查术前虚弱与术后脊柱手术结果之间的关联，包括死亡率、住院时间、再入院、手术部位感染和静脉血栓栓塞性疾病。方法 作为全系统质量改进计划的一部分，自 2016 年 7 月开始，对考虑进行脊柱手术的患者的常规评估中增加了虚弱评估。使用风险分析指数 (RAI) 评估虚弱，并将患者归类为非虚弱 (RAI) 0-29) 或体弱前/体弱 (RAI ≥ 30)。使用分类数据的 Fisher 精确检验或连续数据的 Wilcoxon 秩和检验分析非虚弱和体弱前/虚弱患者之间的比较。结果 从 2016 年 8 月到 2018 年 9 月，668 名患者（年龄 59.5 ± 13.3 岁）记录了术前 RAI 评分并接受了预定的脊柱手术。体弱前体和体弱患者在手术日期后 90 天（1.9% 对 0.2%，P < .05）和 1 年（5.1% 对 1.2%，P < .01）的死亡率相对较高。他们的住院时间 (LOS) 也更长（3.9 d ± 3.6 vs 3.1 d ± 2.8，P < .001）和更高的 60 d（14.6% vs 8.2%，P < .05）和 90 d （15.8% 对 9.8%，P < .05）再入院。结论 术前虚弱，由 RAI 测量，与脊柱手术后再次入院和 90 天和 1 年死亡率的风险增加有关。RAI 可用于对脊柱患者进行分层并告知术前手术决策。