Citation

Banaszek D, Inglis T, Marion TE, Charest-Morin R, Moskven E, Rivers CS, Kurban D, Flexman A, Ailon T, Dea N, Kwon BK, Paquette SJ, Fisher CG, Dvorak MF, Street J. J. Neurotrauma 2019; ePub(ePub): ePub.

Affiliation

University of British Columbia, Orthopaedics, Vancouver, British Columbia, Canada; John.Street@vch.ca.

Copyright

(Copyright © 2019, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2019.6581

PMID

31407621

Abstract

Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were prospectively identified from 2004-2016. We examined effect of patient age, admission Total Motor Score (TMS), and modified frailty index (mFI) on Adverse Events (AEs), acute Length of Stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for 3 age groups: <60, 61-75, 76+ years), and multivariable analysis was performed to investigate the impact of age, TMS and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS (p=0.0375), but not of AEs (p=0.1428) or in-hospital mortality (p=0.1245). In patients <60 years, mFI predicted number of AEs, acute LOS, and in-hospital mortality. Age was not predictive of any outcome variables. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcome in those <75 years only. The inter-relationship of advanced age and decreased physiologic reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger tSCI may be useful for perioperative optimization, risk stratification, and patient counseling.

Language: en

Keywords

AGE; RECOVERY; SURGERY; TRAUMATIC SPINAL CORD INJURY; spinal cord injury