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. 2025 Jun 1;10(2):78-86.
doi: 10.22540/JFSF-10-078. eCollection 2025 Jun.

Shifts in Frailty in A Nationwide Cohort of Spinal Stenosis Patients in Germany During the COVID-19 Pandemic

Hanna von Riegen  1   2 , Nehad Abduljawwad  1   2 , Hussain Gheewala  1   2 , Ralf Kuhlen  3 , Julius Dengler  1   2 , Sven Hohenstein  4 , Andreas Bollmann  4   5 , Nora Dengler  1   2
Affiliations

Shifts in Frailty in A Nationwide Cohort of Spinal Stenosis Patients in Germany During the COVID-19 Pandemic

Hanna von Riegen et al. J Frailty Sarcopenia Falls. .

Abstract

Objectives: To examine shifts in frailty among spinal stenosis patients during the COVID-19 pandemic and associations with interventions and outcomes.

Methods: This retrospective analysis compared types of management and rates of in-hospital mortality between pre-pandemic (January 1, through December 31, 2019) and pandemic phases (March 5, 2020 through May 17, 2022) among spinal stenosis patients across a network of 76 hospitals in Germany, utilizing logistic generalized linear mixed models. Frailty was quantified using the Hospital Frailty Risk Score (HFRS) and categorized as low (<5 points), intermediate (5-15 points), and high (>15 points).

Results: Among the 59,130 patients with spinal stenosis, 39,448 were hospitalized during the pandemic, and 19,682 in 2019. During the pandemic, the proportion of patients with high frailty rose from 4.7%-5.5% to 6.2%-7.3% (p < 0.01), except in pandemic wave 5. Among low frailty patients, rates of decompressive surgery increased from 42.4%-46.0% to 48.4%-52.8% (p<0.001), and of fusion surgery from 15.7%-16.6% to 19.2%-22.8% (p<0.001). Throughout the pandemic, in-hospital mortality rates increased from 0.8%-1.0% to 1.0%-2.5% (p<0.017), yet without differences across frailty groups.

Conclusions: Among those hospitalized for spinal stenosis during the COVID-19 pandemic in Germany, frailty increased and low frailty was associated with rising rates of spine surgery.

Keywords: COVID-19; Frailty; Hospital Frailty Risk Score; Spinal stenosis.

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Figures

Figure 1
Figure 1
Flow chart describing patient inclusion.
See this image and copyright information in PMC

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