Pediatric Spine Frailty Index Predicts Morbidity and Mortality Following Spinal Deformity Surgery

Abstract

Background: – The purpose of this study was to develop a frailty index for pediatric patients undergoing posterior spinal fusion for deformity correction.Methods: – The National Surgical Quality Improvement Program (NSQIP) Pediatric database was used. Patients <18 years of age who had undergone posterior spinal fusion for the treatment of spinal deformity were included. The outcomes of interest included any adverse events, Clavien-Dindo grade-IV adverse events, mortality, and extended length of stay. Significant variables from the multivariable regression analysis were used to create a frailty index. The frailty index was assessed with use of receiver operating characteristic (ROC) curve analysis of each outcome of interest. The frailty index was externally validated with use of a validation cohort. The rates of the outcomes of interest were expressed as proportions and were stratified by the frailty index score.Results: – The present study included 34, 478 patients (28, 377 in the derivation cohort and 6, 101 in the validation cohort). The frailty index included severe respiratory disease, gastrointestinal disease, neuromuscular disease, cognitive/developmental delay, seizure disorder, and asthma. In the derivation cohort, the area under the curve (AUC) for any adverse event, a Clavien-Dindo grade-IV adverse event, mortality, and extended length of stay were 0.77, 0.85, 0.91, and 0.79, respectively. On external validation, the AUC for any adverse event, a Clavien-Dindo grade-IV adverse event, mortality, and extended length of stay were 0.72, 0.88, 0.90, 0.78, respectively. An increasing frailty index score was associated with increasing rates of all morbidity and mortality outcomes.Conclusions: – The frailty index had good to excellent discrimination for morbidity and mortality. This frailty index allows for better risk stratification and informed decision-making.Level of Evidence: – Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.