P53. Disparities in recovery and survival rates in cervical versus thoracolumbar spinal deformity patients are attributable to frailty status at presentation

Abstract

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) and cervical deformity (CD) surgery has seen great improvements in increasing perioperative patient safety and decreasing patient mortality. Previous studies have also demonstrated relatively higher risk of death in cervical deformity surgeries, yet there remains a paucity of literature comparing and contrasting the comorbidities and predictive factors associated with death in ASD versus CD surgery. <h3>PURPOSE</h3> To assess morbidity and mortality rates and potential correlations with frailty in ASD vs CD patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospective cervical deformity (CD) and adult spinal deformity (ASD) databases. <h3>PATIENT SAMPLE</h3> There were 689 ASD patients, 290 CD patients: 979 total. <h3>OUTCOME MEASURES</h3> Demographic factors; baseline comorbidities; intra/postoperative complications; mortality. <h3>METHODS</h3> Operative CD patients 18yrs with pre-(BL) and up to 5-year (5Y) postoperative radiographic/HRQL data were assessed. Differences in demographics, radiographic alignment, and complication rates were assessed via means comparison analyses. Conditional backstep binary logistic regression analysis identified predictive factors for mortality. Kaplan-Meier curves assessed survivorship of expired patients. Cox regression assessed survivability adjusting for BL frailty status. Logrank analysis determined differences in the survival distribution between ASD and CD patients. <h3>RESULTS</h3> A total of 625 patients met inclusion criteria (417 ASD, 208 CD). Within 5Y, 12 ASD patients (2.88% of ASD cohort) and 16 CD patients (7.69% of CD cohort) expired (p=.004). At baseline, ASD and CD patients differed significantly in BL Frailty score (0.29 vs 0.41, p.05). No significant differences were noted in BL disability per EQ5D-VAS (p>.05). In terms of baseline self-reported comorbidities in expired patients, the three most common for ASD patients were: arthritis (46%), hypertension (31%) and anemia (23%). In CD patients, the three most common comorbid conditions were: osteoporosis (50%), previous myocardial infarction (17%) and any cancer (17%). Complications analysis revealed no significant differences in major, minor or intraoperative complications between ASD or CD patients, nor between expired vs living patients (all p>.05). Similarly, there were no significant differences in mortality overall within 30 days, between 30 and 90 days, nor >90 days after surgery between ASD or CD patient cohorts (all p>.05). Regression analysis revealed that when accounting for age, BMI and gender, only frailty status remained a significant predictor of death overall (p=.047). Mean survival time for ASD was 84.11 weeks versus 65.17 in CD patients(χ2(1)=.748, p=.387). <h3>CONCLUSIONS</h3> Total 5-year all-cause mortality in adult spinal deformity and cervical deformity patients remains below 3% despite high rates of comorbidities, suggesting rigorous patient selection criteria plays an important role in maintaining the safety of such surgeries. This study demonstrates that while cervical deformity patients demonstrate greater incidence of death postoperatively, significantly increased baseline frailty status may be the principle cause of such results and should be considered when assessing surgical risks versus benefits. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.