14. Frailty phenotype predicts surgical outcomes but not revisions in patients with spinal deformity

BACKGROUND CONTEXT Risk stratifying patients and predicting outcomes and complications has become increasingly important in spinal deformity surgery. A frailty phenotype based on strength, exhaustion and energy expenditure and weight loss may be a practical tool to predict a patient's overall outcome and complication rate following surgery. PURPOSE To determine if the frailty phenotype is a predictor of patient reported outcomes, complications and revision rates in adult spinal deformity (ASD) patients. STUDY DESIGN/SETTING Retrospective review of prospective cohort. PATIENT SAMPLE The frailty phenotype was determined on all new patients age ≥ 18 years. A total of 1,708 patients were prospectively enrolled over an 8-year period. Of these, 270 of these patients had a diagnosis of ASD with surgical intervention. OUTCOME MEASURES The frailty phenotype was used to predict VAS scores, EQ5D and Oswestry Disability Scores following surgical intervention along with complications and revision surgery. METHODS All new patients presenting to a tertiary spine clinic were asked to complete the Frailty Phenotype survey from 2014 to 2022. A preoperative frailty phenotype was calculated and patients were classified as robust, prefrail or frail based on previously reported methodology. We performed a retrospective review of prospective data of all patients with a frailty phenotype and then determined those within the cohort with a diagnosis of ASD and subsequent surgical intervention. Preoperative VAS, ODI and EQ5D scores were compared to data at 6 weeks, 3 months and 6 months along with early revision rates and complications at 2-year follow-up. RESULTS A total of 1,708 patients including 874 females were enrolled. Five hundred eighty-one, 671 and 456 patients were classified with mean age as robust (66.43 years SD 11.26), prefrail (66.45 years SD 12.01) and frail (66.87 years SD 10.72), respectively. Of the 1,708 patients, 270 underwent procedures to address ASD. This included 73 patients with robust frailty phenotypes, 105 prefrail patients and 92 frail patients. Frail patients had worse VAS back and leg, ODI and EQ5D scores preoperatively and at 6 months compared to Robust patients. Frail patients had a similar change in VAS, EQ5D and ODI scores following surgery at 6 months. No statistically significant difference in complication and revision rates were measured. All groups experienced significantly improved outcome scores at 6-month follow-up (p≤ 0.01). Each group experience significant improvement in Oswestry Disability Index (ODI) scores at the 6-month follow-up period (Frail preop 58 postop 43, Prefrail 53 postop 39, robust preop 45 postop 24, p<0.05). EQ5D scores similarly improved significantly in all groups from preoperative scores of 0.4, 0.52, and 0.58 to postoperative scores of 0.58, 0.68 and 0.77 in the frail, prefrail and robust groups, respectively (p 0.05). Mean blood loss for Frail and Robust patients were 1035.39 and 888.73, respectively p>0.05). No statistical difference in complication rates was identified. CONCLUSIONS In this cohort the frailty phenotype predicted pre- and postoperative back pain, leg pain, ODI and EQ5D scores in ASD surgery but not revisions or complications. Frailty phenotype is a simple and practical tool which can help prognosticate outcomes for patients undergoing surgery to address ASD and set expectations for surgeons. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Risk stratifying patients and predicting outcomes and complications has become increasingly important in spinal deformity surgery. A frailty phenotype based on strength, exhaustion and energy expenditure and weight loss may be a practical tool to predict a patient's overall outcome and complication rate following surgery. To determine if the frailty phenotype is a predictor of patient reported outcomes, complications and revision rates in adult spinal deformity (ASD) patients. Retrospective review of prospective cohort. The frailty phenotype was determined on all new patients age ≥ 18 years. A total of 1,708 patients were prospectively enrolled over an 8-year period. Of these, 270 of these patients had a diagnosis of ASD with surgical intervention. The frailty phenotype was used to predict VAS scores, EQ5D and Oswestry Disability Scores following surgical intervention along with complications and revision surgery. All new patients presenting to a tertiary spine clinic were asked to complete the Frailty Phenotype survey from 2014 to 2022. A preoperative frailty phenotype was calculated and patients were classified as robust, prefrail or frail based on previously reported methodology. We performed a retrospective review of prospective data of all patients with a frailty phenotype and then determined those within the cohort with a diagnosis of ASD and subsequent surgical intervention. Preoperative VAS, ODI and EQ5D scores were compared to data at 6 weeks, 3 months and 6 months along with early revision rates and complications at 2-year follow-up. A total of 1,708 patients including 874 females were enrolled. Five hundred eighty-one, 671 and 456 patients were classified with mean age as robust (66.43 years SD 11.26), prefrail (66.45 years SD 12.01) and frail (66.87 years SD 10.72), respectively. Of the 1,708 patients, 270 underwent procedures to address ASD. This included 73 patients with robust frailty phenotypes, 105 prefrail patients and 92 frail patients. Frail patients had worse VAS back and leg, ODI and EQ5D scores preoperatively and at 6 months compared to Robust patients. Frail patients had a similar change in VAS, EQ5D and ODI scores following surgery at 6 months. No statistically significant difference in complication and revision rates were measured. All groups experienced significantly improved outcome scores at 6-month follow-up (p≤ 0.01). Each group experience significant improvement in Oswestry Disability Index (ODI) scores at the 6-month follow-up period (Frail preop 58 postop 43, Prefrail 53 postop 39, robust preop 45 postop 24, p<0.05). EQ5D scores similarly improved significantly in all groups from preoperative scores of 0.4, 0.52, and 0.58 to postoperative scores of 0.58, 0.68 and 0.77 in the frail, prefrail and robust groups, respectively (p 0.05). Mean blood loss for Frail and Robust patients were 1035.39 and 888.73, respectively p>0.05). No statistical difference in complication rates was identified. In this cohort the frailty phenotype predicted pre- and postoperative back pain, leg pain, ODI and EQ5D scores in ASD surgery but not revisions or complications. Frailty phenotype is a simple and practical tool which can help prognosticate outcomes for patients undergoing surgery to address ASD and set expectations for surgeons.