Frailty severity linked with hospital factors in adults undergoing deformity surgery
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Hospital-acquired conditions, such as surgical site infection and urinary tract infection, worsened among adult patients undergoing spinal deformity surgery who had an increased frailty score, based on findings from a retrospective review study.
For the study, which focused on the possible influence patient frailty had on the development of hospital-acquired conditions, Katherine E. Pierce, BS, Peter G. Passias, MD, and colleagues used a frailty score as a preoperative metric for 9,143 patients in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database who underwent adult spinal deformity surgery from 2005 to 2016. The outcome measures used included rates of hospital-acquired conditions within 30 days of surgery.
Researchers analyzed findings for the frailty grade they used, which was defined using the NSQIP five-factor frailty index, as well as other clinical covariates.
“We demonstrated that increased frailty severity correlated with increased complications, readmissions and length of stay. Furthermore, assessing the relationship between frailty status and various postoperative outcomes suggest that frailty stands as an important preoperative risk assessment within this specific national cohort of operative adult spinal deformity patients,” Pierce, a research fellow, and Passias, a clinical associate professor in the department of orthopedic surgery at NYU Langone Health, told Healio Orthopedics.
Among the patients studied, the rates of overall never events decreased from 14.3% in 2005 to 5.9% in 2016. In all, 6.2% of patients developed at least one hospital-acquired condition, the most common of which was urinary tract infection with a 2.62% rate, based on the results.
The modified frailty score used assessed patient frailty on a zero to one scale, in which no frailty is a score of less than 0.3, mild frailty is a score of 0.3 to 0.5, and severe frailty is a score greater than 0.5.
An assessment of postoperative complications showed significantly greater incidences of such complications as acute renal failure, sepsis, myocardial infarction and pneumonia when a patient had a severe frailty score.
“These results can also be used to prognosticate adverse events during preoperative counseling and to facilitate perioperative resource allocation,” Pierce and Passias said. – by Susan M. Rapp
Reference:
Pierce K, et al. ePaper 034. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosures: Passias reports he receives other financial or material support from AlloSource; receives research support from Cervical Scoliosis Research Society; is a paid presenter or speaker for Globus Medical and Zimmer; and is a paid consultant for Medicrea and Spine Wave. Pierce reports no relevant financial disclosures.
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