Journal of Korean Neurosurgical Society

  • 제63권6호
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  • Pages.827-833
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  • 2020
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Prediction of Risk Factors after Spine Surgery in Patients Aged >75 Years Using the Modified Frailty Index

  • Kim, Ji-Yoon (Department of Anesthesiology, Pain and Critical Care Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • Park, In Sung (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Kang, Dong-Ho (Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Lee, Young-Seok (Department of Neurosurgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University) ;
  • Kim, Kyoung-Tae (Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Hong, Sung Jin (Department of Anesthesiology, Pain and Critical Care Medicine, Yeouido St. Mary's Hospital, College of Medicine, Catholic University of Korea)
  • 투고 : 2020.01.22
  • 심사 : 2020.03.11
  • 발행 : 2020.11.01
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초록

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/㎠), 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.

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참고문헌

  1. Adams P, Ghanem T, Stachler R, Hall F, Velanovich V, Rubinfeld I : Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery. JAMA Otolaryngol Head Neck Surg 139 : 783-789, 2013 https://doi.org/10.1001/jamaoto.2013.3969
  2. Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, et al. : Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes 5 : 222-228, 2012 https://doi.org/10.1161/CIRCOUTCOMES.111.963157
  3. Ali R, Schwalb JM, Nerenz DR, Antoine HJ, Rubinfeld I : Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J Neurosurg Spine 25 : 537-541, 2016 https://doi.org/10.3171/2015.10.SPINE14582
  4. Cabrerizo S, Cuadras D, Gomez-Busto F, Artaza-Artabe I, Marin-Ciancas F, Malafarina V : Serum albumin and health in older people: review and meta analysis. Maturitas 81 : 17-27, 2015 https://doi.org/10.1016/j.maturitas.2015.02.009
  5. Flexman AM, Charest-Morin R, Stobart L, Street J, Ryerson CJ : Frailty and postoperative outcomes in patients undergoing surgery for degenerative spine disease. Spine J 16 : 1315-1323, 2016 https://doi.org/10.1016/j.spinee.2016.06.017
  6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. : Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56 : M146-M156, 2001 https://doi.org/10.1093/gerona/56.3.M146
  7. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF : Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg 134 : 36-42, 1999 https://doi.org/10.1001/archsurg.134.1.36
  8. Goeteyn J, Evans LA, De Cleyn S, Fauconnier S, Damen C, Hewitt J, et al. : Frailty as a predictor of mortality in the elderly emergency general surgery patient. Acta Chir Belg 117 : 370-375, 2017 https://doi.org/10.1080/00015458.2017.1337339
  9. Hackett NJ, De Oliveira GS, Jain UK, Kim JY : ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 18 : 184-190, 2015 https://doi.org/10.1016/j.ijsu.2015.04.079
  10. Iqbal J, Denvir M, Gunn J : Frailty assessment in elderly people. Lancet 381 : 1985-1986, 2013 https://doi.org/10.1016/S0140-6736(13)61203-9
  11. Jain A, Hassanzadeh H, Puvanesarajah V, Klineberg EO, Sciubba DM, Kelly MP, et al. : Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity: analysis of 3519 patients. J Neurosurg Spine 27 : 534-539, 2017 https://doi.org/10.3171/2017.3.SPINE161011
  12. Kovacs J, Moraru L, Antal K, Cioc A, Voidazan S, Szabo A : Are frailty scales better than anesthesia or surgical scales to determine risk in cardiac surgery? Korean J Anesthesiol 70 : 157-162, 2017 https://doi.org/10.4097/kjae.2017.70.2.157
  13. Leven DM, Lee NJ, Kothari P, Steinberger J, Guzman J, Skovrlj B, et al. : Frailty index is a significant predictor of complications and mortality after surgery for adult spinal deformity. Spine (Phila Pa 1976) 41 : E1394-E1401, 2016 https://doi.org/10.1097/BRS.0000000000001886
  14. Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G; Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) : Recommendations for the use of albumin and immunoglobulins. Blood Transfus 7 : 216-234, 2009
  15. Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al. : Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210 : 901-908, 2010 https://doi.org/10.1016/j.jamcollsurg.2010.01.028
  16. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K : Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr 2 : 1, 2002 https://doi.org/10.1186/1471-2318-2-1
  17. Mitnitski AB, Mogilner AJ, Rockwood K : Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 1 : 323-336, 2001 https://doi.org/10.1100/tsw.2001.58
  18. Montomoli J, Erichsen R, Antonsen S, Nilsson T, Sorensen HT : Impact of preoperative serum albumin on 30-day mortality following surgery for colorectal cancer: a population-based cohort study. BMJ Open Gastroenterol 2 : e000047, 2015 https://doi.org/10.1136/bmjgast-2015-000047
  19. Rockwood K, Song X, Mitnitski A : Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey. CMAJ 183 : E487-E494, 2011 https://doi.org/10.1503/cmaj.101271
  20. Torpy JM, Lynm C, Glass RM : Frailty in older adults. JAMA 296 : 2280, 2006 https://doi.org/10.1001/jama.296.18.2280
  21. Tsiouris A, Hammoud ZT, Velanovich V, Hodari A, Borgi J, Rubinfeld I : A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res 183 : 40-46, 2013 https://doi.org/10.1016/j.jss.2012.11.059
  22. Zizza CA, Ellison KJ, Wernette CM : Total water intakes of communityliving middle-old and oldest-old adults. J Gerontol A Biol Sci Med Sci 64 : 481-486, 2009

피인용 문헌

  1. Surgical treatment of senile spinal diseases vol.64, pp.3, 2020, https://doi.org/10.5124/jkma.2021.64.3.191
  2. Central Sarcopenia, Frailty and Comorbidity as Predictor of Surgical Outcome in Elderly Patients with Degenerative Spine Disease vol.64, pp.6, 2021, https://doi.org/10.3340/jkns.2021.0074