Background: There are many studies on the impact of frailty on postoperative complications; however, there are few studies focusing on stepwise propensity score matching (PSM) to offset the influence of age.
Methods: We gathered data for patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. According to the Fried frailty phenotype, we categorized patients into non-frail, pre-frail, and frail groups, then, stepwise PSM for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Univariate and multivariate logistic regressions were used to determine the impact of clinical demographics on postoperative complications.
Results: A total of 559 consecutive patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PSM, we found that pre-frail patients were more vulnerable to develop urinary retention (p = 0.031) and surgical site infections (p = 0.021) than non-frail patients. Longer length of stay (LOS), delayed ambulation and removal of urinary catheter times were observed in pre-frail patients. However, there was a significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reactive protein (CRP) and frail status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with complications between pre-frail and frail patients.
Conclusion: After PSM, we found higher rates of urinary retention and surgical site infections in pre-frail patients than in non-frail patients. CRP was independently related to postoperative complications, while frail status was only independently associated with postoperative complications between pre-frail and non-frail patients. Pre-frail/frail patients tended to have more severe stress responses than non-frail patients.



中文翻译：

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体弱对接受短水平后路腰椎椎间融合术患者围手术期结局的影响：逐步倾向评分匹配分析

背景：关于衰弱对术后并发症影响的研究较多；然而，很少有研究关注逐步倾向得分匹配（PSM）以抵消年龄的影响。
方法：我们收集了 2021 年 1 月至 2021 年 12 月接受短节段后路腰椎椎间融合术的患者的数据。根据 Fried 衰弱表型，我们将患者分为非衰弱、衰弱前和衰弱组，然后根据年龄进行逐步 PSM ，性别，美国麻醉医师协会（ASA）和融合水平进行了保持组之间的可比临床数据。单变量和多变量逻辑回归用于确定临床人口统计学对术后并发症的影响。
结果：共有 559 名具有完整医疗记录的连续患者入组（237 名男性和 322 名女性；平均年龄 72.55 ± 5.86 岁）。在 PSM 之后，我们发现体弱前的患者比非体弱患者更容易发生尿潴留 (p = 0.031) 和手术部位感染 (p = 0.021)。在体弱前的患者中观察到更长的住院时间 (LOS)、延迟的行走和拔除导尿管的时间。然而，只有体弱前和体弱患者之间的 LOS 存在显着差异。二元逻辑回归显示，C反应蛋白（CRP）和体弱状态与非体弱和体弱前患者的术后并发症独立相关，而只有CRP与体弱前和体弱患者之间的并发症独立相关。
结论：PSM 后，我们发现体弱前患者的尿潴留率和手术部位感染率高于非体弱患者。CRP 与术后并发症独立相关，而衰弱状态仅与衰弱前和非衰弱患者的术后并发症独立相关。体弱前/体弱的患者往往比非体弱的患者有更严重的压力反应。