Prediction of Risk Factors after Spine Surgery in Patients Aged >75 Years Using the Modified Frailty Index
김지윤, 박인성, 강동호, 이영석, 김경태, 홍성진,
소속 상세정보
김지윤 ( Kim Ji-Yoon )
Kyungpook National University School of Medicine Kyungpook National University Chilgok Hospital Department of Anesthesiology, Pain and Critical Care Medicine
박인성 ( Park In-Sung )
Gyeongsang National University School of Medicine Gyeongsang National University Hospital Department of Neurosurgery
강동호 ( Kang Dong-Ho )
Gyeongsang National University School of Medicine Gyeongsang National University Hospital Department of Neurosurgery
이영석 ( Lee Young-Seok )
Kyungpook National University School of Medicine Kyungpook National University Chilgok Hospital Department of Neurosurgery
김경태 ( Kim Kyoung-Tae )
Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Neurosurgery
홍성진 ( Hong Sung-Jin )
Catholic University College of Medicine Yeouido St. Mary’s Hospital Department of Anesthesiology and Pain Medicine
Abstract
Objective: Spine surgery is associated with higher morbidity and mortality rates in elderly patients. The modified Frailty Index (mFI) is an evaluation tool to determine the frailty of an individual and how preoperative status may impact postoperative survival and outcomes. This study aimed to determine the usefulness of mFI in predicting postoperative complications in patients aged ≥75 years undergoing surgery with instrumentation.
Methods: We retrospectively reviewed the perioperative course of 137 patients who underwent thoracolumbar-instrumentation spine surgery between 2011 and 2016. The preoperative risk factors were the 11 variables of the mFI, as well as body mass index (kg/cm2), preoperative hemoglobin, platelet, albumin, creatinine, anesthesia time, operation time, estimated blood loss, and transfusion amount. The 60-day occurrences of complication rates were used for outcome assessment.
Results: Major complications after spinal instrumentation surgery occurred in 34 of 138 patients (24.6%). The mean mFI score was 0.18±0.12. When we divided patients into a pre-frail group (mFI, 0.09-0.18; n=94) and a frail group (mFI ≥0.27; n=44), only the rate of sepsis was statistically higher in the frail group than in the pre-frail group. There were significantly more major complications in patients with low albumin levels or in patients with infection or who had experienced trauma. The mFI was a more useful predictor of postoperative complications than the American Society of Anesthesiologists physical status score.
Conclusion: The mFI can successfully predict postoperative morbidity and mortality in patients aged ≥75 years undergoing spine surgery. The mFI improves perioperative risk stratification that provides important information to assist in the preoperative counselling of patients and their families.
키워드
Frail elderly; Risk assessment; Postoperative complications; Morbidity; Spine
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