Pediatric Spine Frailty Index Predicts Morbidity and Mortality Following Spinal Deformity Surgery

Area of Science:

• Pediatric Surgery
• Orthopedic Surgery
• Health Outcomes Research

Background:

• Posterior spinal fusion is a common procedure for pediatric spinal deformities.
• Accurate risk stratification is crucial for optimizing surgical outcomes in pediatric patients.

Purpose of the Study:

• To develop and validate a novel frailty index specifically for pediatric patients undergoing posterior spinal fusion.
• To enhance risk stratification and inform clinical decision-making in this patient population.

Main Methods:

• Utilized the National Surgical Quality Improvement Program (NSQIP) Pediatric database for a large cohort of pediatric patients.
• Developed a frailty index using significant variables from multivariable regression analysis.
• Assessed the index's performance using receiver operating characteristic (ROC) curve analysis and external validation.

Main Results:

• The final frailty index incorporated severe respiratory disease, gastrointestinal disease, neuromuscular disease, cognitive/developmental delay, seizure disorder, and asthma.
• The index demonstrated good to excellent discrimination for predicting adverse events, mortality, and extended length of stay (AUCs ranging from 0.72 to 0.91).
• Higher frailty index scores were significantly associated with increased rates of morbidity and mortality.

Conclusions:

• The developed pediatric frailty index is a valuable tool for risk stratification in patients undergoing posterior spinal fusion.
• This index can aid clinicians in making more informed decisions regarding surgical planning and patient management.