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Frailty and Surgical Invasiveness Are Independently Associated with Complications in Pediatric Spinal Deformity
Vivien Chan1, Andrea Simmonds2, Luke Maclean1
1Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
Insights
Both patient frailty and surgical invasiveness independently increase risks for pediatric spinal fusion patients. Those with severe frailty undergoing highly invasive procedures face the highest adverse outcomes, necessitating individualized preoperative assessments.
Area of Science:
- Orthopedic Surgery
- Pediatric Spine Surgery
- Patient Safety
Background:
- Perioperative outcomes in pediatric spinal fusion are influenced by patient frailty and surgical invasiveness.
- Understanding the combined impact of these factors is crucial for risk assessment.
Purpose of the Study:
- To determine if frailty and surgical invasiveness independently affect perioperative outcomes in pediatric spinal deformity surgery.
- To analyze outcome rates when frailty and invasiveness are considered together.
Main Methods:
- Retrospective cohort study using the NSQIP Pediatric database (2016-2023).
- Frailty assessed via Pediatric Spine Frailty Index; surgical invasiveness via Pediatric Spine Surgical Invasiveness Index.
- Outcomes included adverse events, reoperations, and readmissions within 30 days; multivariable logistic regression used.
Main Results:
- Increasing surgical invasiveness correlated with higher adverse event, reoperation, and readmission rates across frailty levels.
- Severely frail patients had significantly higher odds of adverse events (OR 6.71), severe events (OR 23.17), reoperations (OR 2.81), and readmissions (OR 4.13) compared to non-frail.
- High surgical invasiveness independently increased odds of adverse events (OR 1.61), severe events (OR 2.10), reoperations (OR 1.62), and readmissions (OR 1.40) versus low invasiveness.
Conclusions:
- Frailty and surgical invasiveness are independent predictors of increased perioperative risk in pediatric spinal fusion.
- The highest adverse outcome rates occurred in severely frail patients undergoing highly invasive procedures.
- Integrating frailty and invasiveness in preoperative assessments can enhance patient counseling and planning.
Background:
The purposes of this study were to determine whether frailty and surgical invasiveness are independently associated with perioperative outcomes and to describe the outcome rates when these 2 risk domains are considered together in pediatric patients undergoing spinal fusion for deformity.
Methods:
This was a retrospective cohort study. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database (2016 to 2023) was queried for patients who underwent spinal fusion for any spinal deformity. Frailty was classified using the Pediatric Spine Frailty Index (non-frail = 0; mildly frail = 1; frail = 2, 3, or 4, severely frail = 5 or 6). Surgical invasiveness was defined using the Pediatric Spine Surgical Invasiveness Index (low, <5; moderate, 5 to 15; high, >15). The outcomes were any adverse event, severe adverse event, unplanned reoperation, and unplanned readmission within 30 days after surgery. Multivariable logistic regression analyses were performed.
Results:
A total of 46,399 patients were included (mean age, 13.8 ± 2.6 years; 67.7% female). Increasing surgical invasiveness was associated with increasingly higher rates of adverse events, severe adverse events, unplanned reoperation, and unplanned readmission across almost all frailty categories. Compared with patients who were non-frail, those who were severely frail had markedly higher odds of any adverse event (OR, 6.71; p < 0.001), severe adverse event (OR, 23.17; p < 0.001), unplanned reoperation (OR, 2.81; p < 0.001), and unplanned readmission (OR, 4.13; p < 0.001). Increasing surgical invasiveness was also independently associated with progressively higher odds of adverse outcomes. Compared with low invasiveness, high invasiveness was associated with increased odds of any adverse event (OR, 1.61; p < 0.001), severe adverse event (OR, 2.10; p < 0.001), unplanned reoperation (OR, 1.62; p < 0.001), and unplanned readmission (OR, 1.40; p < 0.001).
Conclusions:
Both frailty and surgical invasiveness were independently associated with increased perioperative risk in pediatric spinal fusion. Patients with greater frailty who were undergoing more invasive procedures had the highest observed rates of adverse outcomes. Incorporating both patient vulnerability and anticipated operative magnitude into preoperative assessment may support more individualized counseling, shared decision-making, and perioperative planning.
Level Of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
