Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: new concepts: cervical spine: 240. The influence of surgical intervention and sagittal alignment on frailty in adult cervical deformity

Abstract

BACKGROUND CONTEXT Frailty, a decrease in physiologic reserve and increased vulnerability to adverse outcomes, falls, disability, and hospitalization, is a new area of study for patients with cervical deformity (CD). Previously, a cervical deformity frailty index (CD-FI) was described for utilization in preoperative risk stratification. Little is known about how operative intervention influences frailty status in CD patients. PURPOSE The goal of this study was to investigate drivers of postoperative frailty score, and which component variables within the CD-FI algorithm respond to surgical intervention most greatly. STUDY DESIGN/SETTING Retrospective review of a prospective adult cervical deformity database. PATIENT SAMPLE A total of 138 CD patients. OUTCOME MEASURES Patient Reported Outcome Measures (PROMS): EQ5D, SWAL, NDI, and CSDI questionnaires. METHODS CD patients (cervical kyphosis>10°, coronal scoliosis >10°, cSVA >4cm, TS-CL >10°, or CBVA >25°) ≥18 years old, undergoing multilevel fusions with complete baseline (BL) and 1Y CD-FI scores. The CD-FI is scored on a scale between 0 and 1 (no frailty: 0–0.2, frailty: 0.2–0.4, severe frailty: >0.4). Descriptive analysis identified cohort demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t-tests gauged associations between complication occurrence, radiographic parameters, and postoperative Δ in CD-FI total and component scores. Forward hierarchal linear regression models determined the effect of successful surgical intervention (achieving lowest level Ames classification modifiers) on change in frailty total and component scores. RESULTS A total of 138 patients were included (Mean age: 61.0, 61.5% F, 91.6% White, mean BMI: 29.9, CCI: 1.2). BL radiographic parameters: Cervical Lordosis: −6.1, cSVA 39.8, TS-CL 38.7, CBVA 2.9, SVA −6.1, PI-LL 1.6, and PT 19.9. Surgical approaches included 48.4% posterior, 34% combined, 17.6% anterior; mean levels fused was 3.4 anteriorly, 9.0 posteriorly; mean op time was 489.4 minutes, mean EBL was 822.5ccs. Following surgical correction, CD-FI score improved at 1Y (BL:0.44 vs. 1Y:0.27, p CONCLUSIONS Intraoperative complications, correction of sagittal alignment, and improving a patient's ability to read, drive, and chronic exhaustion all significantly influenced postoperative frailty status. This analysis is a first step towards a greater understanding of the dynamic relationship between frailty and correction of cervical deformity.