• Peter G Passias, Oluwatobi O Onafowokan, Peter Tretiakov, Tyler Williamson, Nicholas Kummer, Jamshaid Mir, Ankita Das, Oscar Krol, Lara Passfall, Rachel Joujon-Roche, Bailey Imbo, Timothy Yee, Daniel Sciubba, Carl B Paulino, Andrew J Schoenfeld, Justin S Smith, Renaud Lafage, and Virginie Lafage.
• Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA.
• Spine. 2024 Apr 9.

Study DesignRetrospective Single-Center Study.ObjectiveTo assess the influence of frailty on optimal outcome following ASD corrective surgery.Summary Of Background DataFrailty is a determining factor in outcomes after ASD surgery and may exert a ceiling effect on best possible outcome.MethodsASD patients with frailty measures, baseline and 2-year ODI included. Frailty was classified as Not Frail (NF), Frail (F) and Severely Frail (SF) based on the modified Frailty Index, then stratified into quartiles based on 2-year ODI improvement (most improved designated "Highest"). Logistic regression analyzed relationships between frailty and ODI score and improvement, maintenance, or deterioration. A Kaplan-Meier survival curve was used to analyze differences in time to complication or reoperation.Results393 ASD patients were isolated (55.2% NF, 31.0% F, and 13.7% SF), then classified as 12.5% NF-Highest, 17.8% F-Highest, and 3.1% SF-Highest. The SF-group had the highest rate of deterioration (16.7%, P=0.025) at the second postoperative year but the groups were similar in improvement (NF: 10.1%, F: 11.5%, SF: 9.3%, P=0.886). Improvement of SF patients was greatest at 6 months (ΔODI of -22.6±18.0, P<0.001) but NF and F patients reached maximal ODI at 2 years (ΔODI of -15.7±17.9 and -20.5±18.4, respectively). SF patients initially showed the greatest improvement in ODI (NF: -4.8±19.0, F: -12.4±19.3, SF: -22.6±18.0 at 6 months, P<0.001). A Kaplan-Meier survival curve showed a trend of less time to major complication or reoperation by 2 years with increasing frailty (NF: 7.5±0.381 years, F: 6.7±0.511 years, SF: 5.8±0.757 years; P=0.113).ConclusionsIncreasing frailty had a negative effect on maximal improvement, where severely frail patients exhibited a parabolic effect with greater initial improvement due to higher baseline disability, but reached a ceiling effect with less overall maximal improvement. Severe frailty may exert a ceiling effect on improvement and impair maintenance of improvement following surgery.Level Of EvidenceIII.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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