‘Frailty’ Key Predictor of Spine Surgery Complications

Research teams from the Keck School of Medicine, University of Southern California (USC) and the California Institute of Technology have published the results of a study measuring “frailty” and its effect on postoperative complications in patients with malignant lumbar spine neoplasms.

Their work, “The inclusion of frailty improves predictive modeling for postoperative outcomes in the surgical management of primary and secondary lumbar spine tumors,” appears in the July 6, 2021 edition of World Neurosurgery.

Jeffrey C. Wang, M.D., one of the lead researchers, chief of the Orthopaedic Spine Service and co-director of the USC Spine Center explained the study origins to OTW: “Understanding the factors that help us predict the outcomes of patients with serious spinal issues, may allow us to better select appropriate treatments, appropriate spinal surgeries, and help us understand how to counsel the patient on the different treatment options. It also allows the patients and their families to have a greater understanding the of the risks and benefits of their decisions on their treatments. I hope, in the future, that we use these types of studies and information, along with new technologies, to better predict outcomes for all of our patients.”

To locate patients with malignant neoplasms of the lumbar spine who received a fusion procedure, the researchers used the Nationwide Readmissions Database from 2016 and 2017. “Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups,” wrote the authors. “Propensity score matching for age, sex, CCI, surgical approach, and number of levels fused was implemented between frail and non-frail patients, identifying 533 frail patients and 538 non-frail patients…”

The researchers found that frail patients had significantly higher lengths of stay (LOS), costs, infection, posthemorrhagic anemia, and urinary tract infections. Frail patients were more often discharged to skilled nursing facilities and short-term hospitals than non-frail patients.

It would seem, we mused, that “frailty,” as defined in this study, would have an outsized effect on patient outcomes…so why a study? According to Dr. Wang, “I think the more data we have, the better able we are to predict trends and outcomes. The hope is with AI [artificial intelligence] and machine learning, we can input enough data to obtain more accurate predictions of outcomes and help us to make better clinical decisions. Frailty is becoming more important, and this along with other factors will help us reach our ultimate goals.”

“My concern, specifically for this patient population with malignant spinal tumors, is that everyone wants to have a cure, and most look to surgical treatments to help obtain that potential cure. These patients have serious issues and can be very ill. Many may have unrealistic expectations, and this combined with the fact that surgeons want to provide hope for these conditions, make the decision-making process very complex, needing to consider multiple variables. Studies that help us understand how patients may ultimately do, and the risks involved, should hopefully make the decision-making process more based on facts and accurate predictions.”

In summary, said Dr. Wang, “I hope this study, combined with other data, will allows us to better predict complications, length of stay, costs, and ultimately outcomes, in this set of patients with serious problems. Frailty may be a better predictive variable than other patient factors such as age and perhaps other variables we use currently.”