PT  - JOURNAL ARTICLE
AU  - PETER G. PASSIAS
AU  - COLE A. BORTZ
AU  - KATHERINE E. PIERCE
AU  - HADDY ALAS
AU  - AVERY BROWN
AU  - DENNIS VASQUEZ-MONTES
AU  - SARA NAESSIG
AU  - WALEED AHMAD
AU  - BASSEL G. DIEBO
AU  - TINA RAMAN
AU  - THEMISTOCLES S. PROTOPSALTIS
AU  - AARON J. BUCKLAND
AU  - MICHAEL C. GERLING
AU  - RENAUD LAFAGE
AU  - VIRGINIE LAFAGE
TI  - A Simpler, Modified Frailty Index Weighted by Complication Occurrence Correlates to Pain and Disability for Adult Spinal Deformity Patients
AID  - 10.14444/7154
DP  - 2020 Dec 01
TA  - International Journal of Spine Surgery
PG  - 1031--1036
VI  - 14
IP  - 6
4099  - http://ijssurgery.com//content/14/6/1031.short
4100  - http://ijssurgery.com//content/14/6/1031.full
SO  - Int J Spine Surg2020 Dec 01; 14
AB  - Background: The Miller et al adult spinal deformity frailty index (ASD-FI) correlates with complication risk; however, its development was not rooted in clinical outcomes, and the 40 factors needed for its calculation limit the index's clinical utility. The present study aimed to develop a simplified, weighted frailty index for ASD patientsMethods: This study is a retrospective review of a single-center database. Component ASD-FI parameters contributing to overall ASD-FI score were assessed via Pearson correlation. Top significant, clinically relevant factors were regressed against ASD-FI score to generate the modified ASD-FI (mASD-FI). Component mASD-FI factors were regressed against incidence of medical complications, and factor weights were calculated from regression of these coefficients. Total mASD-FI score ranged from 0 to 21, and was calculated by summing weights of expressed parameters. Linear regression and published ASD-FI cutoffs generated corresponding mASD-FI frailty cutoffs: not frail (NF, <7), frail (7–12), severely frail (SF, >12). Analysis of variance assessed the relationship between frailty category and validated baseline measures of pain and disability at baseline.Results: The study included 50 ASD patients. Eight factors were included in the mASD-FI. Overall mean mASD-FI score was 5.7 ± 5.2. Combined, factors comprising the mASD-FI showed a trend of predicting the incidence of medical complications (Nagelkerke R2 = 0.558; Cox & Snell R2 = 0.399; P = .065). Breakdown by frailty category is NF (70%), frail (12%), and SF (18%). Increasing frailty category was associated with significant impairments in measures of pain and disability: Oswestry Disability Index (NF: 23.4; frail: 45.0; SF: 49.3; P < .001), SRS-22r (NF: 3.5; frail: 2.6; SF: 2.4; P = .001), Pain Catastrophizing Scale (NF: 41.9; frail: 32.4; SF: 27.6; P < .001), and NRS Leg Pain (NF: 2.3; frail: 7.2; SF: 5.6; P = .001).Conclusions: This study modifies an existing ASD frailty index and proposes a weighted, shorter mASD-FI. The mASD-FI relies less on patient-reported variables, and it weights component factors by their contribution to adverse outcomes. Because increasing mASD-FI score is associated with inferior clinical measures of pain and disability, the mASD-FI may serve as a valuable tool for preoperative risk assessment.