Frailty predicts worse outcomes for spine surgery patients with interhospital transfer status: Analysis of 295,875 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019

Kyril L Cole; Alexander J Kassicieh; Kavelin Rumalla; Syed Faraz Kazim; Rachel Thommen; Matthew Conlon; Meic H Schmidt; Christian A Bowers

doi:10.1016/j.clineuro.2022.107519

Frailty predicts worse outcomes for spine surgery patients with interhospital transfer status: Analysis of 295,875 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019

Clin Neurol Neurosurg. 2023 Jan:224:107519. doi: 10.1016/j.clineuro.2022.107519. Epub 2022 Nov 11.

Authors

Kyril L Cole¹, Alexander J Kassicieh², Kavelin Rumalla², Syed Faraz Kazim², Rachel Thommen³, Matthew Conlon⁴, Meic H Schmidt², Christian A Bowers⁵

Affiliations

¹ School of Medicine, University of Utah, Salt Lake City, UT 84132, USA.
² Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM 87106, USA.
³ Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; School of Medicine, New York Medical College, Valhalla, NY 10595, USA; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA.
⁴ School of Medicine, New York Medical College, Valhalla, NY 10595, USA; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA.
⁵ Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM 87106, USA. Electronic address: CABowers@salud.unm.edu.

PMID: 36436435
DOI: 10.1016/j.clineuro.2022.107519

Abstract

Study design: Retrospective analysis of a prospectively maintained database.

Objectives: To evaluate the effects of interhospital transfer (IHT) status, age, and frailty on postoperative outcomes in patients who underwent spine surgery.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent spine surgeries from 2015 to 2019 (N = 295,875). Univariate and multivariable analyses were utilized to analyze the effect of IHT on postoperative outcomes and the contribution of baseline frailty status (mFI-5 score stratified into "pre-frail", "frail", and "severely frail") on outcomes in IHT patients. Effect sizes were summarized by odds ratio (OR) with associated 95% confidence intervals (95% CI).

Results: Of 295,875 patients in the study, 3.3% (N = 9666) were IHT status. On multivariable analysis, controlling for covariates, IHT status was significantly associated with greater likelihood of 30-day mortality (odds ratio [OR] = 9.3), major complications (OR=5.0), Clavien-Dindo (CD) grade IV complications (OR=7.0), unplanned readmission (OR=2.1), unplanned reoperation (OR=2.6), eLOS (OR=16.1), and discharge to non-home destination (OR=12.7) (all P < 0.001). Increasing frailty was significantly associated with poor outcomes in spine surgery patients with IHT status compared to chronological age.

Conclusions: This study provides evidence that IHT status is associated with poor outcomes in spine surgery patients. Furthermore, increasing frailty more than increasing age was a robust predictor of poor outcomes among IHT spine surgical patients. Baseline frailty status, as measured by the mFI-5, may be utilized for preoperative risk stratification of patients with IHT status with anticipated spine surgery.

Keywords: Frailty; Interhospital transfer (IHT); National Surgical Quality Improvement (NSQIP); Postoperative outcomes; Spine surgery.

MeSH terms

Frailty* / epidemiology
Frailty* / etiology
Humans
Postoperative Complications / etiology
Quality Improvement
Reoperation / adverse effects
Retrospective Studies
Risk Assessment
Risk Factors