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Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: the gravity of obesity: 231. The five-item modified frailty index is predictive of 30-day postoperative complications in patients undergoing kyphoplasty vertebral augmentation
Abstract   Peer reviewed

Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: the gravity of obesity: 231. The five-item modified frailty index is predictive of 30-day postoperative complications in patients undergoing kyphoplasty vertebral augmentation

Dale Segal, Jacob M. Wilson and Keith W. Michael
The spine journal, Vol.18(8 Supplement), pp.S114-S115
08/2018
DOI: 10.1016/j.spinee.2018.06.496

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Abstract

Vertebral compression fractures are the most common spine injury seen in elderly patients. Vertebral augmentation is considered a safe and effective treatment. The ability to predict outcomes after kyphoplasty based on comorbidities is lacking. The modified frailty index has been used to predict complications after orthopedic and surgical procedures. We hypothesized that despite a low rate of adverse outcomes, postoperative complications following kyphoplasty would be higher in frail patients. Determine whether 5-item modified frailty index scores correlate with postoperative complications in patients undergoing kyphoplasty. Retrospective analysis of prospectively collected data. Of the 2,465 patients who underwent kyphoplasty in The American College of Surgeon's-National Surgery Quality Improvement Program (ACS-NSQIP) database, 2,399 had complete data available for further analysis and calculation of mFI. Overall total complication rate, life threatening complications, length of stay, readmission rate. The National Surgical Quality Improvement Program database was queried for patients who underwent kyphoplasty between 2006 and 2015. Complication data including 30-day complications, life threatening complications, reoperation and readmission rate, and length of stay data was recorded. 5-item modified frailty index (5i-mFI) scores were calculated. Univariate analysis and multivariate logistic regression analysis was then conducted to analyze frailty as a predictor of postoperative complications after kyphoplasty. A total of 2,465 patients were identified (mean age=73.98). As 5i-mFI increased from 0 to ≥2, the rate of overall complications increased nearly 3-fold from 3.7% to 10.4% (p<.001) and the rate of life threatening complications increased from 0.8% to 2.4% (p=.042). Additionally, 30-day readmission from 8.9% to 12.9% (p=.005), adverse hospital discharge increased from 7.6% to 25.6% (p<.001) and length of stay from 1.66 days to 3.75 days (p<.001). Frailty was associated with increased total complications, Clavien–Dindo IV complications, length of stay, and 30-day readmission rates. The 5-item modified frailty index is a straightforward assessment tool that correlates with outcomes after kyphoplasty. It can be used to help clinicians predict adverse events and facilitate informed discussions with their patients.

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