Reference
Aim
- Stratifies cervical deformity patients into frailty categories that meaningfully predict risk of major and medical complications after surgery, beyond age or CCI alone
Components
Physician-documented deficits
- More than 3 medical problems
- Anxiety
- BMI <18.5 or >30
- Cancer
- Cardiac disease
- Cerebrovascular disease
- Current disability benefits
- Dementia
- Depression
- Diabetes
- Liver disease
- Lung disease
- Neuromuscular disease
- Osteoporosis
- Pancreatic disease
- Rheumatoid arthritis
- Smoker
- Vascular disease
- Venous disease
- Unsteady gait
Patient-reported / questionnaire-derived deficits
- Bladder incontinence
- Bowel incontinence
- Difficulty driving (NDI Q8)
- Difficulty getting dressed (mJOA)
- Difficulty reading (LSDI Q4)
- Difficulty sleeping more than 6 hours (LSDI Q9; SWAL-QOL Q9b/d)
- Difficulty walking without an assistive device (mJOA)
- Feeling anxious or depressed most of the time (EQ-5D-3L)
- Feeling tired most of the time (SWAL-QOL Q9c)
- Feeling weak most of the time (SWAL-QOL Q9a)
- Feeling worn out or exhausted most of the time (SWAL-QOL Q9e)
- General health <50 on EQ VAS
- Inability to concentrate (LSDI Q6)
- Inability to do normal work/schoolwork/housework (NDI Q7)
- Inability to engage in normal recreational activity (LSDI Q10)
- Inability to lift heavy objects (LSDI Q3)
- Inability to perform normal activities (EQ-5D-3L)
- Inability to walk (EQ-5D-3L)
- Leg weakness
- Personal care dependency (LSDI Q2)
Scoring
- Based on a proportion out of 40 (max score)
- Frail (<0.2)
- Frail (0.2–0.4)
- Severely frail (>0.4)
Outcome
- Severely frail patients having markedly higher odds of a major complication than not-frail patients (OR 43, 95% CI 2.7–684 on multivariate analysis).
- Frailty correlates with medical complications (gamma 0.30) but not clearly with surgical/technical complications, suggesting it reflects systemic vulnerability rather than operative difficulty per se