49. Increasing surgical invasiveness relative to frailty status in cervical deformity surgery: a risk benefit analysis

Abstract

BACKGROUND CONTEXT The Adult Spinal Deformity Invasiveness Index incorporates deformity-specific components to assess the magnitude of correction. It's unknown how invasiveness relates to outcomes in each frailty state. PURPOSE Investigate the relationship between increasing invasiveness and outcomes in ASD surgery in each frailty states. STUDY DESIGN/SETTING Retrospective review of prospective, consecutively enrolled multicenter ASD database. PATIENT SAMPLE A total of 195 ASD patients with baseline demographic and surgical details. OUTCOME MEASURES Invasiveness, frailty, minimal clinically important differences (MCID) for the Oswestry Disability Index, SF-36 Physical Component Scores, and Scoliosis Research Society Scores. METHODS ASD patients (scoliosis ≥20°, SVA ≥5cm, PT ≥25°, or TK ≥60°) with baseline frailty and invasiveness scores. Invasiveness index included; posterior: decompression (1), fusion (2), instrumentation (1), osteotomies: 3-coloumn (14), Ponte (1), interbody fusion; anterior lumbar (8), transforaminal/posterior lumbar (2), iliac fixation (2), revision surgery (3). Invasiveness scores were calculated within different frailty states (not frail, NF, 0.5). Logistic regression analysis assessed the relationship between increasing invasiveness and major complications or reoperations and meeting MCID for any of the measured HRQLs at 3 years. Decision tree analysis assessed thresholds for an invasiveness risk benefit cutoff point, above which experiencing complications or reoperations and not reaching MCID were higher. Significance was set to p RESULTS One hundred ninety-five of 322 patients met inclusion criteria. Baseline demographic info: age 59.9 ± 14.4, 75% female, BMI 27.8 ± 6.2, CCI 1.7 ± 1.7. Baseline surgical info: 61% osteotomy, 52% decompression, 11.0 ± 4.1 levels fused. There were 98 NF, 65 F, and 30 SF patients. For the entire cohort, binary regression analysis found a significant relationship between increasing invasiveness and experiencing a major complication or reoperation (1.01 [1.00-1.02], p=0.01). Within each frailty subgroup, the results were 1.01 ([1.00-1.03], p=0.05) for NF, 1.01 ([1.01-1.02], p CONCLUSIONS Increasing invasiveness is associated with increased odds of major complications and reoperations. A risk/benefit cutoff for decreasing major complications/reoperations and meeting MCID was found to be 79.3 for NF patients, 111 for F patients, and 53.3 for SF patients. Above these thresholds, increasing invasiveness is associated with increasing the risk of major complications or reoperations and not meeting MCID at 3 years. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.