P32. Impact of controlled vs uncontrolled mFI-5 frailty on perioperative complications following adult spinal deformity surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Preoperative risk assessment is crucial before adult spinal deformity, due to its relatively high surgical invasiveness and likelihood of complications. Frailty has been found across multiple surgical subspecialties to be associated with risk of complications. However, the current frailty measures do not account for whether certain points refer to a controlled or uncontrolled condition. <h3>PURPOSE</h3> The goal of this study was to sub-stratify the mFI-5 frailty index into controlled or uncontrolled and assess the relationship to perioperative complications. We hypothesize that patients with uncontrolled frailty have a higher risk for perioperative complications following adult spinal deformity (ASD) surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> ASD patients with fusion of=5 vertebral levels were identified. <h3>OUTCOME MEASURES</h3> The primary outcome of this study was perioperative complication rates. <h3>METHODS</h3> Frailty was calculated using mFI-5. Uncontrolled frailty was defined as having any of the following mFI-5 components: 1) blood pressure >140/90, 2) HbA1C > 7%, or 3) COPD exacerbation, while on medication. Patients were then divided into three cohorts: nonfrail, controlled frail and uncontrolled frail. Bivariate analysis was first performed. Multivariable analysis assessed the relationship between frailty state and perioperative complication. <h3>RESULTS</h3> A total of 178 ASD patients were identified. There were 97 nonfrail, 54 controlled frail and 27 uncontrolled frail patients. Patients with uncontrolled frailty were more likely to be >60 years old (84% vs 24%), have hyperlipidemia (42% vs 20%), ODI >42 (84% vs 52%) (p 60 years old (41% vs 24%), hyperlipidemia (52% vs 20%) (p 42, and age >65. Uncontrolled frailty was associated with 4.24x greater odds of any major complication and 9.47x odds of any wound complication. Controlled frailty was not associated with increased risk of perioperative complications (p>0.05 for all). <h3>CONCLUSIONS</h3> The results of this study suggest that patients with uncontrolled frailty have higher risk of perioperative complications compared to those with controlled frailty. Furthermore, components of uncontrolled frailty, that did not exist in the current mFI-5 frailty index, represent new modifiable risk factors that can be targeted for preoperative optimization in ASD patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.