Neurosurgery notes/Spine/Deformity/Clinical assessment/Systemic assessment/ASD-FI (Adult spinal deformity fragility index)

ASD-FI (Adult spinal deformity fragility index)

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Systemic assessment

General

  • Calculated based on how many factors are present / how many factors measured
  • Eg: if there are 10 factors present in this 40 factor ASD-FI, the score: 10/40= 0.25

Scoring:

  • Not frail (NF) < 0.3
  • Frail (F) 0.3–0.5
  • Severely frail (SF) > 0.5

Outcome

  • For frail and Severe frail patients, respectively, the adjusted odds of developing proximal junctional kyphosis (OR 2.8 and 3.1) were higher than those for Non Frail patients.
  • The Severe Frail patients had higher odds of developing than (NF patients)
    • Pseudarthrosis (OR 13.0)
    • Deep wound infection (OR 8.0)
    • Wound dehiscence (OR 13.4) (p < 0.05)
    • Reoperation (OR 2.1) (p < 0.05)

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Clinical significance

  • Prediction of Perioperative Complications:
    • Severely frail (SF) patients (ASD-FI score > 0.5 points) have significantly higher odds of experiencing major complications (Odds Ratio (OR) 4.5, 95% CI 2.0–10.0) compared to not frail (NF) patients (score < 0.3 points).
    • These major complications can include intraoperative vascular, visceral, or neurologic injury, deep wound infection, pulmonary embolism, and junctional failure.
  • Prediction of Reoperation:
    • SF patients have significantly higher odds of requiring reoperation (OR 3.9, 95% CI 1.7–8.9) compared to NF patients.
  • Prediction of Length of Hospital Stay:
    • SF patients experience mean hospital stays that are 2.1 times longer (95% CI 1.8–2.4) compared to NF patients. Frail patients (score 0.3-0.5 points) also have longer hospital stays (OR 1.4) compared to NF patients.
  • Prediction of Specific Complications:
    • Higher ASD-FI scores are associated with a higher incidence of proximal junctional kyphosis. Specifically, SF patients have significantly higher odds (OR 7.0, 95% CI 1.4–34) of developing this condition compared to NF patients.
    • The index also predicts a higher incidence of deep wound infection. SF patients show significantly higher odds (OR 9.7, 95% CI 2.3–41) of wound infection compared to NF patients.
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  • Adult Cervical Spinal Deformity Frailty Index (CD-FI) VS Adult Spinal Deformity Frailty Index (ASD-FI) are not the same, but they are closely related.
    • The ASD-FI was developed and validated specifically for patients with adult spinal deformity (not limited to cervical, but including thoracolumbar and lumbar deformity). It comprises ~40 items covering multidisciplinary health deficits (medical, functional, psychosocial).
    • The CD-FI is a cervical-specific frailty index created for adults undergoing cervical deformity surgery. It is based on the methodology and many of the same deficits as the ASD-FI, but was recalibrated for the cervical spine patient population.