1608. Is Frailty responsive to Surgical Correction of Adult Spinal Deformity? An Investigation of Sagittal Re-alignment and Frailty Component Drivers.

Authors: Peter Gust Passias; Frank Segreto, BS; Renaud Lafage, MS; Justin Smith, MD, PhD; Breton Line, BS; D. Kojo Hamilton, MD; Robert Eastlack, MD; Jeffrey Gum, MD; Robert Hart, MD; Shay Bess, MD; ISSG International Spine StudyGroup (Brooklyn Heights, NY)

Introduction: Recently, Miller and colleagues have developed a frailty index (FI) for preoperative risk stratification in adult spinal deformity (ASD) patients. Components of the ASD-FI utilize patient comorbidity history, clinical symptoms, and patient-reported-outcome-measures (PROMS), which may be responsive to surgical intervention. Methods: Operative ASD patients (coronal scoliosis≥20°, SVA≥5cm, PT≥25° and/or thoracic kyphosis>60°) ≥18 years old, with complete baseline(BL) and 1Y ASD-FI scores were included. The ASD-FI is scored from 0-1 (not frail<0.3, frail 0.3-0.5, severely frail>0.5). Pearson correlations and t-tests gauged associations and Δ in radiographic parameters, ASD-FI total and components scores. Forward hierarchal linear regressions gauged effect of successful surgical intervention (achieving lowest SRS-Schwab modifiers) on postoperative frailty. Results: 696 patients were included (cohort demographics, radiographic and surgical details can be seen in Table 1). Following surgical correction, ASD-FI improved (BL:0.34 vs. Y1:0.25, p<0.001). Of the ASD-FI components, 21/40 variables (52.5%) improved, including bowel incontinence, bladder incontinence, leg weakness, imbalance, SF-36 Q1, Q3b-e, Q3i-j, Q9cfgi, Q11d, ODI Q2, Q7-10, SRS22r Q9 (p<0.001). Frailty improvement correlated with Δ in PT (R =0.083), PI-LL (R: 0.240), SVA (R: 0.218), and TPA (R: 0.173), all p<0.05. ASD-FI components SF36 Q3c(Lifting/carrying groceries), ODI Q8(Social Life), ODI Q10(Employment status), and SF36 Q3e(climbing one flight of stairs) were the greatest component drivers of Δ in frailty (R: 0.557, 0.547, 0.534, 0.529; all p<0.001), respectively. Attaining lowest SRS-Schwab modifiers did not predict Δ in component or total frailty scores (R 2 : 0.011, p=0.345). Conclusion: Improvements to a patient’s social life, employment status, carrying groceries, climbing a flight of stairs, overall balance, and lack of leg weakness highly correlated with improved postoperative frailty status. Although sagittal realignment correlated with frailty improvement, additional research is needed to elucidate the association between sagittal alignment and frailty status.