Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P79. Patient frailty is an important contributor to disability in adult spinal deformity (ASD): rationale for routine frailty and deformity assessment

Abstract

BACKGROUND CONTEXT Frailty, defined as the accumulation of physiological deficits, is used in multiple medical specialties to predict complication risk and prolonged hospital stay. Less data exist regarding the contribution of patient frailty toward compromise in patient health related quality of life. ASD frailty assessment may allow for improved patient profiling to predict disability in conjunction with spinal alignment. PURPOSE Evaluate correlations of spinal alignment and patient frailty with pre-treatment pain, disability, and patient reported outcome measures (PROMS). STUDY DESIGN/SETTING Retrospective analysis of a multicenter prospective ASD database. PATIENT SAMPLE ASD patients. OUTCOME MEASURES Oswestry Disability Index (ODI), Scoliosis Research Society-22r questionnaire (SRS-22r), SF-36, numeric rating scale (NRS) back and leg pain METHODS ASD frailty score (range 0.3–6.4) was calculated for ASD patients enrolled into a prospective database using a validated frailty scoring methodology that incorporates patient health deficits from review of systems, past medical history, general health and vitality (as recommended by Rockwood et al). PROM questions that assessed pain and/or physical function were not used in the frailty assessment, nor was patient age, to avoid confounding associations between ASD frailty score and PROMs. Correlations between age, ASA grade, total frailty score, and raw and age adjusted spinal alignment versus preop and postop ODI and SRS-22r were evaluated. ASD cohort was divided into quartiles based on worsening frailty score and propensity score matched (PSM) analysis performed controlling for age adjusted sagittal deformity (SVA, PI-LL) and max scoliosis to evaluate differences in ODI and SRS-22r between lowest (best) and highest (worst) frailty quartiles. RESULTS Mean ASD frailty score for all ASD patients (n=408) was 2.7 (SD=1.2). Correlations between preop demographic, frailty, and alignment parameters vs. preop ODI demonstrated significant associations between age, ASA grade, frailty score, SVA, and PI-LL (p CONCLUSIONS Patient frailty is an important contributor to disability and diminished physical function in ASD. Patient frailty and spinal malalignment both compromise ASD health related quality of life. Efforts should be made to routinely evaluate patient frailty and spinal malalignment when assessing disability magnitude in ASD.