PMID- 33534520 OWN - NLM STAT- MEDLINE DCOM- 20210818 LR - 20230831 IS - 1528-1159 (Electronic) IS - 0362-2436 (Linking) VI - 46 IP - 16 DP - 2021 Aug 15 TI - A Risk-Benefit Analysis of Increasing Surgical Invasiveness Relative to Frailty Status in Adult Spinal Deformity Surgery. PG - 1087-1096 LID - 10.1097/BRS.0000000000003977 [doi] AB - STUDY DESIGN: Retrospective review of a prospectively enrolled multicenter Adult Spinal Deformity (ASD) database. OBJECTIVE: Investigate invasiveness and outcomes of ASD surgery by frailty state. SUMMARY OF BACKGROUND DATA: The ASD Invasiveness Index incorporates deformity-specific components to assess correction magnitude. Intersections of invasiveness, surgical outcomes, and frailty state are understudied. METHODS: ASD patients with baseline and 3-year (3Y) data were included. Logistic regression analyzed the relationship between increasing invasiveness and major complications or reoperations and meeting minimal clinically important differences (MCID) for health-related quality-of-life measures at 3Y. Decision tree analysis assessed invasiveness risk-benefit cutoff points, above which experiencing complications or reoperations and not reaching MCID were higher. Significance was set to P < 0.05. RESULTS: Overall, 195 of 322 patients were included. Baseline demographics: age 59.9 +/- 14.4, 75% female, BMI 27.8 +/- 6.2, mean Charlson Comorbidity Index: 1.7 +/- 1.7. Surgical information: 61% osteotomy, 52% decompression, 11.0 +/- 4.1 levels fused. There were 98 not frail (NF), 65 frail (F), and 30 severely frail (SF) patients. Relationships were found between increasing invasiveness and experiencing a major complication or reoperation for the entire cohort and by frailty group (all P < 0.05). Defining a favorable outcome as no major complications or reoperation and meeting MCID in any health-related quality of life at 3Y established an invasiveness cutoff of 63.9. Patients below this threshold were 1.8[1.38-2.35] (P < 0.001) times more likely to achieve favorable outcome. For NF patients, the cutoff was 79.3 (2.11[1.39-3.20] (P < 0.001), 111 for F (2.62 [1.70-4.06] (P < 0.001), and 53.3 for SF (2.35[0.78-7.13] (P = 0.13). CONCLUSION: Increasing invasiveness is associated with increased odds of major complications and reoperations. Risk-benefit cutoffs for successful outcomes were 79.3 for NF, 111 for F, and 53.3 for SF patients. Above these, increasing invasiveness has increasing risk of major complications or reoperations and not meeting MCID at 3Y.Level of Evidence: 3. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Passias, Peter G AU - Passias PG AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Brown, Avery E AU - Brown AE AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Bortz, Cole AU - Bortz C AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Pierce, Katherine AU - Pierce K AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Alas, Haddy AU - Alas H AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Ahmad, Waleed AU - Ahmad W AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Passfall, Lara AU - Passfall L AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Kummer, Nicholas AU - Kummer N AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Krol, Oscar AU - Krol O AD - Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY. FAU - Lafage, Renaud AU - Lafage R AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. FAU - Burton, Douglas AU - Burton D AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS. FAU - Hart, Robert AU - Hart R AD - Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA. FAU - Anand, Neel AU - Anand N AD - Department of Orthopedic Surgery, Cedars-Sinai Health Center, Los Angeles, CA. FAU - Mundis, Gregory AU - Mundis G AD - San Diego Center for Spinal Disorders, La Jolla, CA. FAU - Neuman, Brian AU - Neuman B AD - Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD. FAU - Line, Breton AU - Line B AD - Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO. FAU - Shaffrey, Christopher AU - Shaffrey C AD - Department of Orthopedics and Neurosurgery, Duke University Medical Center, Durham, NC. FAU - Klineberg, Eric AU - Klineberg E AD - Department of Orthopaedic Surgery, University of California, Davis, Davis, CA. FAU - Smith, Justin AU - Smith J AD - Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA. FAU - Ames, Christopher AU - Ames C AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA. FAU - Schwab, Frank J AU - Schwab FJ AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. FAU - Bess, Shay AU - Bess S AD - Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO. CN - International Spine Study Group LA - eng PT - Journal Article PT - Multicenter Study PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 SB - IM MH - Adult MH - Aged MH - Female MH - *Frailty/diagnosis/surgery MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Neurosurgical Procedures MH - Postoperative Complications/epidemiology/etiology MH - Quality of Life MH - Retrospective Studies EDAT- 2021/02/04 06:00 MHDA- 2021/08/19 06:00 CRDT- 2021/02/03 14:51 PHST- 2021/02/04 06:00 [pubmed] PHST- 2021/08/19 06:00 [medline] PHST- 2021/02/03 14:51 [entrez] AID - 00007632-202108150-00009 [pii] AID - 10.1097/BRS.0000000000003977 [doi] PST - ppublish SO - Spine (Phila Pa 1976). 2021 Aug 15;46(16):1087-1096. doi: 10.1097/BRS.0000000000003977.