Frailty Is a Better Predictor than Age of Mortality and Perioperative Complications after Surgery for Degenerative Cervical Myelopathy: An Analysis of 41,369 Patients from the NSQIP Database 2010-2018.

Jamie R F Wilson,Jetan H Badhiwala,Michael G Fehlings,Jefferson R Wilson,Albert Yee,Ali Moghaddamjou

doi:10.3390/jcm9113491

Abstract

Background: The ability of frailty compared to age alone to predict adverse events in the surgical management of Degenerative Cervical Myelopathy (DCM) has not been defined in the literature. Methods: 41,369 patients with a diagnosis of DCM undergoing surgery were collected from the National Surgical Quality Improvement Program (NSQIP) Database 2010–2018. Univariate analysis for each measure of frailty (modified frailty index 11- and 5-point; MFI-11, MFI-5), modified Charlson Co-morbidity index and ASA grade) were calculated for the following outcomes: mortality, major complication, unplanned reoperation, unplanned readmission, length of hospital stay, and discharge to a non-home destination. Multivariable modeling of age and frailty with a base model was performed to define the discriminative ability of each measure. Results: Age and frailty have a significant effect on all outcomes, but the MFI-5 has the largest effect size. Increasing frailty correlated significantly with the risk of perioperative adverse events, longer hospital stay, and risk of a non-home discharge destination. Multivariable modeling incorporating MFI-5 with age and the base model had a robust predictive value (0.85). MFI-5 had a high categorical assessment correlation with a MFI-11 of 0.988 (p < 0.001). Conclusions and Relevance: Measures of frailty have a greater effect size and a higher discriminative value to predict adverse events than age alone. MFI-5 categorical assessment is essentially equivalent to the MFI-11 score for DCM patients. A multivariable model using MFI-5 provides an accurate predictive tool that has important clinical applications.

Highlights

Degenerative cervical myelopathy (DCM) is characterized by progressive compression of the spinal cord in the cervical canal, producing debilitating neurological deficits in upper limb function, gait instability, sphincteric disturbance, and spastic quadriparesis
A total of 41,369 patients with the ICD-9/ICD-10 diagnostic code for DCM were identified from the National Surgical Quality Improvement Program (NSQIP) database
On univariate analysis, increasing frailty (MFI-5/MFI-11) had the largest effect size for mortality, major complication and discharge to non-home destination. This effect remained in the multivariable model, but the effect size was largest for mortality and unplanned reoperation. These findings suggest that physiological reserve is much more of a driver of perioperative complications when compared to age alone

Summary

Introduction

Degenerative cervical myelopathy (DCM) is characterized by progressive compression of the spinal cord in the cervical canal, producing debilitating neurological deficits in upper limb function, gait instability, sphincteric disturbance, and spastic quadriparesis It is the most common cause of adult spinal cord dysfunction worldwide and its prevalence increases significantly with age [1]. DCM is an umbrella term that encompasses a number of degenerative pathologies that include osteoarthritis (spondylosis), ligament disease (ossification of the posterior longitudinal ligament (OPLL), ligament hypertrophy), and degenerative listhesis or instability These entities have pronounced effects on the functional abilities and quality of life of impaired individuals, which may be comparable to serious health conditions, such as cancer or heart disease [8]. A multivariable model using MFI-5 provides an accurate predictive tool that has important clinical applications

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