Oral Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Purpose: Frailty, a state of increased vulnerability to stress, has recently been associated with postoperative complications and outcomes in various fields. The purpose of this study was to investigate the relationships between frailty and postoperative clinical outcomes in palliative surgery for spinal metastases.

Methods: We prospectively evaluated 273 patients with spinal metastases who underwent palliative surgery enrolled in our Cancer Board from 2015 to 2021. The modified 5-item frailty index (mFI-5) was adopted to assess frailty, with a score of 0 defined as the Non-frailty group, 1 as the Pre-frailty group, and 2 or more as the Frailty group. The following parameters were assessed: patient background (age, gender, BMI, smoking, steroids, new Katagiri score, SINS, radiation therapy, chemotherapy, number of fusion segments, operation time, estimated blood loss), postoperative complications, postoperative clinical scores, and life expectancy. Postoperative complications were defined as Grade 2 or higher using the Clavien-Dindo classification. Clinical scores were compared between the three groups in terms of ECOGPS, Barthel Index, and EQ5D up to 6 months postoperatively. Kaplan-Meier curves were generated and compared for life expectancy.

Results: This study included 172 males and 101 females with a mean age of 67.7 years (range, 24–92 years) at the time of surgery. The complication rate was 19% (52 patients), significantly higher in the Frailty group (Non-frailty/Pre-frailty/Frailty group, 11%/15%/30%, p = 0.01), especially for severe complications (Grade 4 and 5) (Non-frailty/Pre-frailty/Frailty group, 0%/0%/6%). ECOGPS was significantly lower in the Non-frailty group than the Pre-frailty and Frailty groups (3 months postoperatively, Non-frailty/Pre-frailty/Frailty group, median 1/2/2, p < 0.01). Barthel Index and EQ5D were significantly higher in the Non-frailty group than the Pre-frailty and Frailty groups (3 months postoperatively, Non-frailty/Pre-frailty/Frailty group, Barthel Index; 97.6/81.4/77.1, p < 0.01, EQ5D; 0.883/0.640/0.597, p < 0.01). The Kaplan-Maier curve showed that there was a significantly longer prognosis in the Non-frailty group than the Pre-frailty and Frailty groups (p < 0.01) (Figure 1).

Discussion: Recently, mFI-5 has been used as a predictor of perioperative risks for various surgery. This study suggests that mFI-5 is also useful as a predictor of postoperative clinical scores and life expectancy in palliative surgery for spine metastases. Furthermore, this study indicates that the degree of frailty of patients with spinal metastases was associate with poor postoperative outcome including postoperative complications, clinical scores, and life expectancy.