P102. Chronological comparison of existing frailty indices to predict complications throughout the postoperative course following adult spinal deformity surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> The comparison of various frailty indices and their ability to predict complications after ASD surgery has not been investigated. <h3>PURPOSE</h3> Assess whether certain frailty indices have predictability of complication rates following ASD surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>PATIENT SAMPLE</h3> A total of 689 ASD patients. <h3>OUTCOME MEASURES</h3> Complication rates, clinical outcomes, cost-utility. <h3>METHODS</h3> Operative ASD patients with baseline (BL) and 2-year (2Y) data were included. Four frailty indices were used for comparison: Passias et al modified ASD frailty index (mFI), Miller et al ASD frailty index (FI-ASD), the ACS-NSQIP 5-Factor frailty index (ACS-FI5), and the FRAIL Scale (PMID:29792992). Patients were stratified into not frail (NF), frail (F) and severely frail (SF). Associations of the indices with EBL, op time, complications, hospital-acquired conditions (HAC: UTI, DVT/PE, SSI), reoperations, SICU stay, and LOS were compared using one-way ANOVA, logistic and linear regression analyses. <h3>RESULTS</h3> There were 421 ASD patients included (Age: 60.4, BMI: 28.0, CCI: 1.9). Total cohort complication rates: 71% any comp, 27% major (68% were surgical, 32% medical), 35% minor, 25% intraoperative, 18% mechanical, 22% underwent reoperation. Upon presentation, severely frail patients were much more likely to present with a severe ODI (OR: 16, [7.2-29.8]). All four indices significantly correlated with intraop details and comps. During hospital stay, all four indices correlated to SICU time and total LOS. Only FRAIL Scale correlated with SICU admission rate (OR: 1.2, [1.03-8.8]), while no index was predictive of comps prior to discharge (all p>.05). ASD-FI had the strongest correlation with periop comps, including HACs (OR: 1.2, [1.1-6.3]), any (OR: 1.2, [1.02-7.3]) and major comps (OR: 1.5, [1.1-4.7]). When assessing 2Y comps, logistic regression analysis demonstrated correlation between ASD-FI, mFI, and FRAIL Scale indices and any comps, major comps and reoperation. However, mFI was the only correlate for all 2Y comps (any, major, minor, mech, reop), along with highest OR for predicting mechanical comps (OR: 1.6, [1.3-1.9]). Clinically, ASD-FI SF group had the greatest improvement (ODI,SRS-Total), while mFI SF had lowest rates of improvement. Given their higher complication rates, this translated to higher cost per QALY by 2 years for SF pts when stratified by mFI (p<.001). <h3>CONCLUSIONS</h3> Frailty imposes a significant burden on adult spinal deformity patients from the moment of presentation through cost-utility at two years. Assessing frailty by different measures demonstrated meaningful differences in complications and outcomes. These findings highlight the impact of frailty stratification during surgical planning to effectively assess the risk of patients undergoing corrective surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.