Key result
Pre-frailty was independently associated with an increased risk of postoperative complications compared to non-frailty (OR 2.080) in older patients undergoing short-level posterior lumbar interbody fusion.
Why the study?
While frailty is known to impact postoperative complications, studies using stepwise propensity score matching to offset the confounding effect of age were limited.
Does frailty status impact postoperative complications and length of stay in older patients undergoing short-level posterior lumbar interbody fusion?
Cohort (n=559)
No
Does frailty status impact postoperative complications and length of stay in older patients undergoing short-level posterior lumbar interbody fusion?
Odds Ratio: 2.08 (95% CI 1.108–3.907)
p-value: p=0.023
Pre-frailty and frailty are associated with increased postoperative complications, longer length of stay, and greater surgical stress response in older patients undergoing short-level posterior lumbar interbody fusion.
May warrant frailty screening before lumbar fusion; hypothesis-generating for targeted risk-reduction trials.
Background There were many literatures reporting the impact of frailty on postoperative complications, however, studies according to stepwise propensity score matching (PSM) to offset the influence of age were limited.Methods We gathered data for all patients undergoing short-level posterior lumbar interbody fusion from January to December 2021. Accroding to Fried frailty phenotype, we segragated patients into three groups (not-frailty, pre-frailty, and frailty), then, stepwise propensity score matching for age, sex, American Society of Anesthesiologists (ASA) and fusion levels were performed to keep comparable clinical data between groups. Uni- and multivariate logistic regression were used to identify the impact of clinical demographics on postoperative complications.Results A total consecutive 559 patients with complete medical records were enrolled (237 males and 322 females; mean age 72.55 ± 5.86 years). After PS matching, we found pre-frail patients were more vulnerable to develop urinary retention ( p = 0.031 ) and surgical site infection ( p = 0.021 ) than non-frail patients. Meanwhile, longer length of stay (LOS), ambulation time and removal of urinary catheter time were observed in pre-frail patients. However, there was significant difference only in LOS between pre-frail and frail patients. Binary logistic regression revealed that C-reaction protein (CRP) and frailty status were independently associated with postoperative complications between non-frail and pre-frail patients, while only CRP was independently correlated with that of between pre-frail and frail patients.Conclusions In this study, after PS matching, we found higher rate of urinary retention and surgical site infection in pre-frail patients than that of non-frail patients. CRP was independently related to postoperative complications, while frailty status was only independently associated with postoperative complications between pre-frail and non-frail patients. And pre-frail/frail patients tended to have severer stress response than that of non-frail patients.
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Lu et al. (2022) conducted a cohort in Lumbar disk herniation, lumbar spinal stenosis, and lumbar spondylolisthesis (n=559). Pre-frailty vs. Non-frailty was evaluated on Postoperative complications (OR 2.080, 95% CI 1.108-3.907, p=0.023). Pre-frailty was independently associated with an increased risk of postoperative complications compared to non-frailty (OR 2.080) in older patients undergoing short-level posterior lumbar interbody fusion.
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