Association Of Preoperative Frailty With Adverse Postoperative Outcomes In Elderly Patients Undergoing Elective Spinal Surgery

Objective: This study aims to investigate the relationship between a brief preoperative frailty assessment and the occurrence of adverse postoperative outcomes in elective spinal surgery in the elderly.Methods: The trial is a prospective cohort study.The participants selected for the study were elderly patients undergoing elective spinal surgery at Shengjing Hospital of China Medical University.A total of 231 elderly patients aged 65 years or older were assessed for preoperative frailty using the "FRAIL" scale,a brief frailty screening scale that covers five main aspects: fatigue,endurance,mobility,disease status,and weight,within 1 week before surgery.Follow-up was conducted within 30 days after surgery to obtain information about postoperative recovery.The primary outcome indicator was the occurrence of postoperative complications.Complications of interest included postoperative infections(respiratory,urinary,and surgical site infections),cardiovascular complications,blood transfusions,electrolyte disturbances,and problems with postoperative feeding.Secondary outcome indicators were prolonged hospital stay and adverse postoperative course.The trial has been registered with the Chinese Clinical Trials Registry under registration number Chi CTR2100049677.Results: A total of 207 patients were eventually analyzed in this study,of whom 101(48.8%)were male and 106(51.2 %)were female.The median age of the cohort was69(67-72)years.Preoperative frailty assessment resulted in 30(14.5%)being healthy,121(58.5%)being prefrail and 56(27.1%)being frail.A total of 65(31.4 %)of the207 patients experienced postoperative complications.In a multifactorial analysis,frailty(score ≥3)(OR,4.80;95% CI,1.1-20.96)and ASA classification ≥3(OR,2.53;95% CI,1.23-5.21)were independent risk factors for the development of postoperative complications.ASA classification ≥3(OR,2.21;95% CI,1.046-4.69)was significantly associated with a prolonged hospital stay.Patients with frailty(score ≥3)(OR,6.426;95%CI,1.13-36.69)or ASA classification ≥3(OR,4.10;95% CI,1.71-9.83)were at increased risk of adverse postoperative course(CCI above the 75 th percentile).Conclusion: In geriatric elective spinal surgery,preoperative assessment with the brief frailty screening scale can help identify individuals at high potential risk of postoperative adverse events.