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Meta-Analysis
. 2023 Nov 23;23(1):771.
doi: 10.1186/s12877-023-04448-2.

Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis

Wonhee Baek  1 , Sun-Young Park  2 , Yoonjoo Kim  3
Affiliations
Meta-Analysis

Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis

Wonhee Baek et al. BMC Geriatr. .

Abstract

Background: Degenerative spinal diseases are common in older adults with concurrent frailty. Preoperative frailty is a strong predictor of adverse clinical outcomes after surgery. This study aimed to investigate the association between health-related outcomes and frailty in patients undergoing spine surgery for degenerative spine diseases.

Methods: A systematic review and meta-analysis were performed by electronically searching Ovid-MEDLINE, Ovid-Embase, Cochrane Library, and CINAHL for eligible studies until July 16, 2022. We reviewed all studies, excluding spinal tumours, non-surgical procedures, and experimental studies that examined the association between preoperative frailty and related outcomes after spine surgery. A total of 1,075 articles were identified in the initial search and were reviewed by two reviewers, independently. Data were subjected to qualitative and quantitative syntheses by meta-analytic methods.

Results: Thirty-eight articles on 474,651 patients who underwent degenerative spine surgeries were included and 17 papers were quantitatively synthesized. The health-related outcomes were divided into clinical outcomes and patient-reported outcomes; clinical outcomes were further divided into postoperative complications and supportive management procedures. Compared to the non-frail group, the frail group was significantly associated with a greater risk of high mortality, major complications, acute renal failure, myocardial infarction, non-home discharge, reintubation, and longer length of hospital stay. Regarding patient-reported outcomes, changes in scores between the preoperative and postoperative Oswestry Disability Index scores were not associated with preoperative frailty.

Conclusions: In degenerative spinal diseases, frailty is a strong predictor of adverse clinical outcomes after spine surgery. The relationship between preoperative frailty and patient-reported outcomes is still inconclusive. Further research is needed to consolidate the evidence from patient-reported outcomes.

Keywords: Frailty; Meta-analysis; Patient-reported outcome measures; Spine surgery; Systematic review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses-based flowchart of the article screening and selection process
Fig. 2
Fig. 2
Health-related outcomes in terms of preoperative frailty status. IADL, instrumental activities of daily living; EQ-5D, EuroQol-5D; JOA, Japanese orthopedic association scale; mJOA, modified Japanese orthopedic association scale; NDI, neck disability index; ODI, Owestry disability index; NRS, numerical rating scale; PQRS, postoperative quality of recovery scale; ADL, activity of daily living; SF-36, 36-item short-form survey; SRS-22, Scoliosis Research Society 22-question; VAS, visual analog scale; QALY, quality-adjusted life years; ICU, intensive care unit
Fig. 3
Fig. 3
Forest plots of the clinical outcomes that showed significant results in the meta-analysis. SSI, surgical site infection; OR, odds ratio; MD, mean difference; CI, confidence interval
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References

    1. Yolcu YU, Helal A, Alexander AY, Bhatti AU, Alvi MA, Abode-Iyamah K, Bydon M. Minimally invasive Versus Open Surgery for degenerative spine disorders for Elderly patients: experiences from a single Institution. World Neurosurg. 2021;146:e1262–9. doi: 10.1016/j.wneu.2020.11.145. - DOI - PubMed
    1. Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar Fusion Procedure Rates and Associated Hospital costs for degenerative spinal Diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 2019;44(5):369–76. doi: 10.1097/brs.0000000000002822. - DOI - PubMed
    1. Beschloss A, Dicindio C, Lombardi J, Varthi A, Ozturk A, Lehman R, Lenke L, Saifi C. Marked increase in spinal deformity Surgery throughout the United States. Spine (Phila Pa 1976) 2021;46(20):1402–8. doi: 10.1097/brs.0000000000004041. - DOI - PubMed
    1. Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S. Epidemiological trends in spine Surgery over 10 years in a multicenter database. Eur Spine J. 2018;27(8):1698–703. doi: 10.1007/s00586-018-5513-4. - DOI - PubMed
    1. Neifert SN, Martini ML, Yuk F, McNeill IT, Caridi JM, Steinberger J, Oermann EK. Predicting trends in cervical spinal Surgery in the United States from 2020 to 2040. World Neurosurg. 2020;141:e175–81. doi: 10.1016/j.wneu.2020.05.055. - DOI - PubMed

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