Predicting Short-Term Outcome After Surgery for Primary Spinal Tumors Based on Patient Frailty

Frailty, decreased physiologic reserve and increased vulnerability to stressors beyond what is expected for normal aging, is associated with increased risk of morbidity and mortality. The objective of this study was to develop a preoperative frailty index for patients undergoing surgery for primary spinal column tumors that predicts morbidity, mortality, and length of stay.

The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients who underwent surgery for a primary spinal tumor. The spinal tumor frailty index, consisting of 9 items, was applied to each patient. Patients were characterized as "not frail" (0), "mildly frail" (1), "moderately frail" (2), and "severely frail" (≥3).

Inclusion criteria were met by 1589 patients. Overall major complication rate was 10.6%. Compared with patients without frailty, patients with mild (odds ratio 3.83; 95% confidence interval, 2.63-5.58), moderate (odds ratio 6.80; 95% confidence interval, 4.10-11.3), and severe frailty (odds ratio 13.05; 95% confidence interval, 6.34-26.87) had significantly increased odds of developing complications (all P < 0.001). Mean length of stay was 6.4 days ± 0.2, 9.8 days ± 0.6, 14.4 days ± 1.7, and 18.3 days ± 2.6 for patients without frailty, with mild frailty, with moderate frailty, and with severe frailty (P < 0.05 between all groups).

Compared with patients without frailty, patients with mild, moderate, and severe frailty had significantly increased odds of developing postoperative complications. Systematic evaluation of preoperative frailty should play a key role in decision making for patients undergoing surgery for primary spinal tumors.