53. Determination of risk benefit thresholds for corrective adult spinal deformity surgery with consideration of frailty and severity of sagittal malalignment at presentation

• Published in: The spine journal Vol. 22; no. 9; pp. S27 - S28
• Main Authors: Krol, Oscar, Passias, Peter G., Joujon-Roche, Rachel, Williamson, Tyler, McFarland, Kimberly, Tretiakov, Peter, Lebovic, Jordan, Owusu-Sarpong, Stephane, Vira, Shaleen N.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2022
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2022.06.067

Adult spinal deformity is associated with severe pain and disability. Recent literature has shown that surgical intervention can significantly improve patient's quality of life and lessen disease burden. As many patients requiring spine surgery are elderly and often frail, restoration of alignment targets may differ. There is paucity in literature on whether different frailty and deformity states may warrant a different level of surgical invasiveness. To investigate the effect of frailty and deformity severity on appropriate surgical invasiveness. Retrospective cohort study from multicenter database. This study included 381 adult spinal deformity (ASD) patients. Complications; health-related quality of life (HRQL); Oswestry Disability Index (ODI). Operative ASD patients (scoliosis >20, SVA>5cm, PT>25, or TK>60) with available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. The ASD-FI was used to stratify patients into 2 categories: Not Frail (NF): 20. Four groups were formed by frailty and deformity severity: NF Low, F Low, NF Sev, F Sev. ANCOVA determined differences in Surgical Invasiveness (SI) among F/D groups. Logistic regression determined significant association between SI and reaching Ideal Clinical outcome (ICO), defined as: no major complications, no reoperations, and reaching MCID for ODI. Surgical Invasiveness (SI) was normalized to a scale of 0-100 using the SI range. Thresholds for invasiveness and achieving ICO were found through conditional inference tree (CIT) analysis. A total of 381 ASD patients (59.3±15yrs, 26.9± kg/m2, CCI: 1.52±1.6, FI: 3.09±1.6) were included and underwent surgery (11.6±4 lvls fused, EBL: 1522±1275 mL, op time: 337±124 min, LOS: 7.3±3.9 days), with 62.2% having a posterior-only approach, 36.5% combined approach, 46% having a decompression and 65% an osteotomy. By deformity severity: 60% Low-Mod, 40% Severe, while frailty assessment was 49% NF, and 51% F. This categorized the patients into deformity/frailty groups as follows: 35% NF Low, 13% NF Sev, 22% F Low, 25% F Sev. Patients had a significantly different degree of SI: 35 NF Low/Mod, 38 F Low/mod, 48 NF Sev, 50 F Sev (p<0.001). CIT analysis found NF Sev patients had a higher likelihood of reaching ICO with an SI below 40 (OR: 3.6, 95% CI: 1.1-12.1, p=.037), and F Sev with a SI below 30 (OR: 4.6, 95% CI: 1.7-12.6, p=.003). Low/mod groups revealed no significant association between invasiveness and achieving ICO. Analysis of increasing surgical invasiveness in patients stratified by frailty and baseline deformity showed frail severely deformed patients, compared with non-frail severely deformed patients, had a lower invasiveness threshold above which there was a higher risk of major complications, reoperations and failure to reach clinically important improvement in ODI. This abstract does not discuss or include any applicable devices or drugs.