Prognostic Significance of Baseline Frailty Status in Traumatic Spinal Cord Injury

作者：Alis J. Dicpinigaitis, Fawaz Al‐Mufti, Phillip O. Bempong, Syed Faraz Kazim, Jared Cooper, Jose F. Dominguez, Alan L. Stein, Piyush Kalakoti, Simon Hanft, Jared M. Pisapia, Merritt Drew Kinon, Chirag D. Gandhi, Meic H. Schmidt, Christian A. Bowers · 发表于：Neurosurgery · 年份：2022 · DOI：10.1227/neu.0000000000002088 · 被引用次数：17 · 研究领域：Frailty in Older Adults、Spinal Cord Injury Research、Traumatic Brain Injury Research

BACKGROUND: Literature evaluating frailty in traumatic spinal cord injury (tSCI) is limited. OBJECTIVE: To evaluate the prognostic significance of baseline frailty status in tSCI. METHODS: Patients with tSCI were identified in the National Inpatient Sample from 2015 to 2018 and stratified according to frailty status, which was quantified using the 11-point modified frailty index (mFI). RESULTS: Among 8825 operatively managed patients with tSCI identified (mean age 57.9 years, 27.6% female), 3125 (35.4%) were robust (mFI = 0), 2530 (28.7%) were prefrail (mFI = 1), 1670 (18.9%) were frail (mFI = 2), and 1500 (17.0%) were severely frail (mFI ≥ 3). One thousand four-hundred forty-five patients (16.4%) were routinely discharged (to home), and 320 (3.6%) died during hospitalization, while 2050 (23.3%) developed a severe complication, and 2175 (24.6%) experienced an extended length of stay. After multivariable analysis adjusting for age, illness severity, trauma burden, and other baseline covariates, frailty (by mFI-11) was independently associated with lower likelihood of routine discharge [adjusted odds ratio (aOR) 0.82, 95% CI 0.77-0.87; P < .001] and development of a severe complication (aOR 1.17, 95% CI 1.12-1.23; P < .001), but not with in-hospital mortality or extended length of stay. Subgroup analysis by age demonstrated robust associations of frailty with routine discharge in advanced age groups (aOR 0.71 in patients 60-80 years and aOR 0.69 in those older than 80 years), w...