Optimization is a Moving Target

Authors:
Publisher website
Google Scholar
Abstract
Study Design.: Retrospective analysis of a multicenter complex adult spinal deformity (ASD) cohort. Objectives.: Develop a simplified, weighted, and modifiable ASD Frailty Index (o-ASD-FI) that incorporates modifiable health components. Background.: Though newer frailty indices have emerged, none specifically addresses complex ASD while incorporating modifiable health factors. Methods.: Miller’s ASD-FI variables were evaluated via Pearson bivariate correlation and multiple stepwise regression. Ten frailty and three modifiable health factors (depression, diabetes, and osteoporosis) were identified and regressed against mortality, extended length of stay (LOS > 8 d), revisions, and major complications. Coefficients were weighted using Johnson’s method to create the o-ASD-FI (range: 0 – 18). Frailty categories were defined as: not frail (P P P P <0.01. Conclusions.: The newly developed simplified, weighted, and optimizable ASD Frailty Index (o-ASD-FI) incorporates modifiable health components, providing a robust assessment of physiological status and potentially superior risk stratification compared with existing tools for both primary and revision complex spinal deformity surgery. Level of Evidence: III