Impact of Frailty on Morbidity and Mortality in Adult Patients Presenting with an Acute Traumatic Cervical Spinal Cord Injury

Autor: Isaac K. Agboola, Mani Ratnesh S. Sandhu, Aladine A. Elsamadicy, Isaac G. Freedman, Andrew B. Koo, John Havlik, Josiah Sherman, Maxwell Laurans, Luis Kolb, Astrid Hengartner, Dirk C. Johnson, Richard C. Maduka, Benjamin C. Reeves
Rok vydání: 2021
Předmět:
Zdroj: World Neurosurgery. 153:e408-e418
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2021.06.130
Popis: The aim of this study was to determine if baseline frailty was an independent predictor of adverse events (AEs) and in-hospital mortality in patients being treated for acute cervical spinal cord injury (SCI).A retrospective cohort study was performed using the National Trauma Database (NTDB) from 2017. Adult patients (18 years old) with acute cervical SCI were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic and procedural coding systems. Patients were categorized into 3 cohorts based on the criteria of the 5-item modified frailty index (mFI-5): mFI = 0, mFI = 1, or mFI≥2. Patient demographics, comorbidities, type of injury, diagnostic and treatment modality, AEs, and in-patient mortality were assessed. A multivariate logistic regression analysis was used to identify independent predictors of in-hospital AEs and mortality.Of 8986 patients identified, 4990 (55.5%) were classified as mFI = 0, 2328 (26%) as mFI = 1, and 1668 (18.5%) as mFI≥2. On average, the mFI≥2 cohort was 5 years older than the mFI = 1 cohort and 22 years older than the mFI = 0 cohort (P0.001). Most patients in each cohort sustained either complete SCI or central cord syndrome after a fall or transport accident (mFI = 0, 77.31% vs. mFI = 1, 89.5% vs. mFI≥2, 93.65%). With respect to in-hospital events, the proportion of patients who experienced any AE increased significantly along with frailty score (mFI = 0, 30.42% vs. mFI = 1, 31.74% vs. mFI≥2, 34.95%; P0.001). In-hospital mortality followed a similar trend, increasing with frailty score (mFI = 0, 10.53% vs. mFI = 1, 11.33% vs. mFI≥2, 16.23%; P0.001). On multivariate regression analysis, both mFI = 1 1.21 (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4; P = 0.008) and mFI≥2 (OR, 1.23; 95% CI, 1.05-1.45; P = 0.012) predicted AEs, whereas only mFI≥2 was found to be a predictor for in-hospital mortality (OR, 1.45; 95% CI, 1.14-1.83; P = 0.002).Increasing frailty is associated with an increased risk of AEs and in-hospital mortality in patients undergoing treatment for cervical SCI.
Databáze: OpenAIRE
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