Friday, September 28, 2018 4:05 PM–5:05 PM abstracts: tumor and deformity

BACKGROUND CONTEXT Frailty, a relative new medical diagnosis defined by a reduced physiological reserve, has been associated with vulnerability to adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity (ASD-FI) was developed. Components of the ASD-FI utilize patient comorbidity history, clinical symptoms, and patient-reported-outcome-measures (PROMS). PURPOSE The goal of our study was to investigate components of the ASD-FI that are most responsive to operative intervention, and drive overall frailty score at 1Y. STUDY DESIGN/SETTING Retrospective review of a prospective multicenter adult spinal deformity database. PATIENT SAMPLE A total of 696 ASD patients. OUTCOME MEASURES PROMS: Short Form 36 (SF36) Total and Component Scores, Oswestry Disability Index (ODI). METHODS ASD patients (defined as: coronal scoliosis ≥20°, SVA ≥5cm, pelvic tilt ≥25° and/or thoracic kyphosis >60°) ≥18 years old, undergoing multilevel fusions, with complete baseline (BL) and 1Y ASD-FI scores were included. The ASD-FI is scored on a scale between 0 and 1 (no frailty: 0.5). Descriptive analysis assessed cohort demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t -tests assessed postoperative changes to ASD-FI score components, ASD-FI total scores, and radiographic parameters. Forward hierarchal linear regression models determined the effect of successful surgical intervention (achieving lowest level SRS-Schwab classification modifiers) on change in frailty total and component scores. RESULTS A total of 696 patients were included (Mean age: 59.6, 77.4% F, 91.2% White, Mean BMI: 27.8, Mean CCI: 1.76). BL radiographic parameters: SS: 30.6, PI-LL: 16.0, PT: 24.1, SVA: 67.3, TPA: 23.7. Surgical approaches included 0.7% anterior, 69.7% posterior, 29.6% combined; 50.7% of patients had prior spine surgery, 16.4% of patients underwent staged procedures, 63.2% had an osteotomy, mean op time was 373.6 minutes, mean EBL was 1591.14ccs, mean levels fused was 5.2 anteriorly, 11.1 posteriorly, mean LOS was 7.7 days. Following surgical correction, ASD-FI score improved at 1Y (BL:0.34 vs. Y1:0.25, p CONCLUSIONS Improvements to a patient's social life, employment status, carrying groceries, climbing a flight of stairs, overall balance, and lack of leg weakness all highly correlated with improved postoperative frailty status. Although sagittal realignment correlated with frailty improvement, additional research and deformity sub-group analyses are needed to describe the association between frailty and sagittal realignment in adult spinal deformity.