44. The impact of frailty on patient reported outcome measures following elective thoracolumbar spine surgery

Abstract

BACKGROUND CONTEXT Frailty has been shown to be a risk predictor for perioperative adverse events (AEs) in patients undergoing various type of spine surgery. However, its relationship with Patient Related Outcome Measures (PROMS) remains unknown. PURPOSE The primary objective of this study was to determine the impact of frailty on PROMS in patients undergoing surgery for thoracolumbar degenerative conditions. The secondary objective was to determine the association between frailty and baseline PROMS. STUDY DESIGN/SETTING This is a retrospective study of a prospective cohort of patients who underwent surgery between 2012 and 2018. PATIENT SAMPLE Patients >55 years old who underwent surgery for thoracolumbar degenerative conditions. OUTCOME MEASURES Patient data and PROMS (EQ-5D, SF-12, ODI, back and leg pain NRS) were extracted from the Canadian Spine Outcomes and Research Network registry for a single academic center. Frailty was retrospectively calculated using the modified frailty index (mFI) and patients were classified as frail, prefrail and nonfrail. METHODS Patient characteristics and outcomes were analyzed using ANOVA or Kruskal-Wallis test for continuous variables and chi-square or Fisher's exact test for proportions. A generalized estimating equations (GEEs) regression model was used to assess the association between patients’ baseline frailty status and PROMs measures at three and 12 months. RESULTS A total of 293 patients were included with a mean age of 67±7 years. Twenty-two percent of the patients (n= 65) were frail, 59 % (n=172) were prefrail and 19% (n=56) were nonfrail. At baseline, the three groups had similar PROMS, except for the PCS which was worse in the frail group (mean difference [95% CI], -4.9 [-8.6;-1.1], p= 0.0083). The improvement in the EQ-5D, PCS, MCS, ODI, back and leg pain NRS scores was not significantly different between the three groups (p> 0.05). The was no difference in the evolution of the PROMS at three and 12 months between the three groups (p> 0.05). CONCLUSIONS Although frailty is a known predictor of AEs, it does not predict worse PROMS after spine surgery in that population. At baseline, nonfrail, prefrail and frail patients have similar PROMS. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.