PMID- 38202121 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240312 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 13 IP - 1 DP - 2023 Dec 25 TI - Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery. LID - 10.3390/jcm13010114 [doi] LID - 114 AB - Introduction: Frailty has been shown to negatively influence patient outcomes across many disease processes, including in the cervical spondylotic myelopathy (CSM) population. The aim of this study was to assess the impact that frailty has on patients with CSM who undergo anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF). Materials and Methods: A retrospective cohort study was performed using the 2016-2019 national inpatient sample. Adult patients (>/=18 years old) undergoing ACDF only or PCDF only for CSM were identified using ICD codes. The patients were categorized based on receipt of ACDF or PCDF and pre-operative frailty status using the 11-item modified frailty index (mFI-11): pre-Frail (mFI = 1), frail (mFI = 2), or severely frail (mFI >/= 3). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS) and non-routine discharge (NRD). Results: A total of 37,990 patients were identified, of which 16,665 (43.9%) were in the pre-frail cohort, 12,985 (34.2%) were in the frail cohort, and 8340 (22.0%) were in the severely frail cohort. The prevalence of many comorbidities varied significantly between frailty cohorts. Across all three frailty cohorts, the incidence of AEs was greater in patients who underwent PCDF, with dysphagia being significantly more common in patients who underwent ACDF. Additionally, the rate of adverse events significantly increased between ACDF and PCDF with respect to increasing frailty (p < 0.001). Regarding healthcare resource utilization, LOS and rate of NRD were significantly greater in patients who underwent PCDF in all three frailty cohorts, with these metrics increasing with frailty in both ACDF and PCDF cohorts (LOS: p < 0.001); NRD: p < 0.001). On a multivariate analysis of patients who underwent ACDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.39, p < 0.001; (severely frail) OR: 2.25, p < 0.001] and NRD [(frail) OR: 1.49, p < 0.001; (severely frail) OR: 2.22, p < 0.001]. Similarly, in patients who underwent PCDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.58, p < 0.001; (severely frail) OR: 2.45, p < 0.001] and NRD [(frail) OR: 1.55, p < 0.001; (severely frail) OR: 1.63, p < 0.001]. Conclusions: Our study suggests that preoperative frailty may impact outcomes after surgical treatment for CSM, with more frail patients having greater health care utilization and a higher rate of adverse events. The patients undergoing PCDF ensued increased health care utilization, compared to ACDF, whereas severely frail patients undergoing PCDF tended to have the longest length of stay and highest rate of non-routine discharge. Additional prospective studies are necessary to directly compare ACDF and PCDF in frail patients with CSM. FAU - Elsamadicy, Aladine A AU - Elsamadicy AA AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA. FAU - Sayeed, Sumaiya AU - Sayeed S AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA. FAU - Sherman, Josiah J Z AU - Sherman JJZ AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA. FAU - Craft, Samuel AU - Craft S AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA. FAU - Reeves, Benjamin C AU - Reeves BC AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA. FAU - Lo, Sheng-Fu Larry AU - Lo SL AD - Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA. FAU - Shin, John H AU - Shin JH AD - Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. FAU - Sciubba, Daniel M AU - Sciubba DM AD - Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA. LA - eng GR - UL1 TR001863/TR/NCATS NIH HHS/United States PT - Journal Article DEP - 20231225 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC10779741 OTO - NOTNLM OT - ACDF OT - PCDF OT - cervical spondylotic myelopathy OT - frailty OT - length of stay COIS- The authors declare no conflicts of interest. EDAT- 2024/01/11 07:41 MHDA- 2024/01/11 07:42 PMCR- 2023/12/25 CRDT- 2024/01/11 01:10 PHST- 2023/11/21 00:00 [received] PHST- 2023/12/15 00:00 [revised] PHST- 2023/12/22 00:00 [accepted] PHST- 2024/01/11 07:42 [medline] PHST- 2024/01/11 07:41 [pubmed] PHST- 2024/01/11 01:10 [entrez] PHST- 2023/12/25 00:00 [pmc-release] AID - jcm13010114 [pii] AID - jcm-13-00114 [pii] AID - 10.3390/jcm13010114 [doi] PST - epublish SO - J Clin Med. 2023 Dec 25;13(1):114. doi: 10.3390/jcm13010114.