Frailty as a risk factor for postoperative complications in adult patients with degenerative scoliosis administered posterior single approach, long-segment corrective surgery: a retrospective cohort study

Bin Li,Xianglong Meng,Yong Hai,Xinuo Zhang

doi:10.1186/s12891-021-04186-9

Bin Li, Xianglong Meng + Show 2 more

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https://doi.org/10.1186/s12891-021-04186-9

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Abstract

BackgroundWith the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Frailty, instead of chronological age, is used for assessing the patient’s overall physical condition. In ADS patients undergoing a posterior approach, long-segment corrective surgery, the association of frailty with the postsurgical outcomes remains undefined.MethodsADS patients who underwent a posterior approach, long-segment fusion at the Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University (CMU), Beijing, China, in 2014–2017 were divided into the frailty and non-frailty groups according to the modified frailty index. Major postoperative complications were recorded, including cardiac complications, pneumonia, acute renal dysfunction, delirium, stroke, neurological deficit, deep wound infection, gastrointestinal adverse events, and deep vein thrombosis. Radiographic measurements and health-related quality of life (HRQOL) parameters were recorded preoperatively and at 2 postoperative years.ResultsA total of 161 patients were included: 47 (29.2%) and 114 (70.8%) in the frailty and non-frailty groups, respectively. Major postoperative complications were more frequent in the frailty group than the non-frailty group (29.8% vs. 10.5%, P = 0.002). Multivariable logistic regression analysis showed that frailty was independently associated with major complications (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.12–6.89, P = 0.028). Radiographic and HRQOL parameters were improved at 2 years but with no significant between-group differences.ConclusionsFrailty is a risk factor for postoperative complications in ADS after posterior single approach, long-segment corrective surgery. Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS.

Highlights

With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention
Frailty screening should be applied preoperatively in all patients to optimize the surgical conditions in ADS
Frailty assessment and surgical data Frailty was assessed by the modified frailty index in all patients (Supplementary Table S1), based on data extracted from the electronic medical record system

Summary

Introduction

With the population aging worldwide, adult degenerative scoliosis (ADS) is receiving increased attention. Adult scoliosis, reflected by a coronal Cobb angle of 10° or above in an adult individual, mainly includes adult idiopathic scoliosis (AdIS) and de novo adult degenerative scoliosis (ADS) and occurs during adulthood due to progressive degenerative changes [1]. With the population aging worldwide, ADS attracts increasing attention and since it imposes living and economic burdens on patients and their families. Conservative treatments, such as drug therapy, traction, massage, acupuncture, and epidural steroid injection, represent the first-line treatments for ADS, but surgical treatment is recommended in case of unsatisfactory conservative treatment [3]. Aggravating scoliosis and neurological symptoms often result in severe chronic back pain, radiating leg pain, and neurogenic claudication in ADS patients [5]

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