P110. Should age adjusted realignment goals vary based on patient frailty status in adult spinal deformity?

Abstract

<h3>BACKGROUND CONTEXT</h3> Adaptation of age-adjusted alignment has gained popularity for its correlation with clinical improvement and lowering rates of proximal junctional kyphosis. Age-adjusted parameters correlate with outcomes. However, frailty may be a better predictor of each following ASD surgery. <h3>PURPOSE</h3> To adjust the Sagittal Age-Adjusted Score (SAAS) to accommodate frailty in alignment considerations will increase the predictability of clinical outcomes and junctional failure. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>PATIENT SAMPLE</h3> A total of 689 ASD Patients. <h3>OUTCOME MEASURES</h3> Mechanical complications, PJF, PJK and ODI. <h3>METHODS</h3> Included: surgical ASD pts with 2Y data. Frailty assessed by ASD modified Frailty Index (ASD-mFI). Outcomes: proximal junctional kyphosis (PJK) and failure (PJF), major mechanical complications, and Smith et al Best Clinical Outcome (BCO), defined as ODI 4.5. Linear regression analysis established a 6W score based on SAAS component scores, frailty and ODI US norms per published by Lafage et al. Logistic regression followed by conditional inference tree (CIT) analysis generated categorical thresholds. Logistic regression analysis controlling for age, baseline deformity and revision status generated odds ratios for the continuous score. Thirty percent of the cohort was used as a random sample for internal validation. <h3>RESULTS</h3> There were 412 pts included. BL frailty categories: 57% not frail, 30% frail and 14% severely frail. Overall, by 2Y, 39% of patients developed PJK, 8% PJF, 21% mechanical complications, 22% underwent reoperation and 15% met BCO. SAAS only correlated with development of PJF. The ASD-mFI demonstrated correlation with all outcomes except PJK (all p1.4, offset: 0.75-1.4, sseverely offset: .05). Internal validation saw these outcomes maintain significance between categories, with significant adjusted correlation to meeting BCO (OR: 3.8, 1.1-13.5; p=.037). <h3>CONCLUSIONS</h3> Consideration of physiologic age, in addition to chronological age, may be beneficial in management of operative goals to maximize clinical outcomes while minimizing junctional failure. This combination enables the spine surgeon to fortify a surgical plan for even the most challenging patients undergoing adult spinal deformity surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.