NYMC Faculty Publications

Prognostic Significance of Baseline Frailty Status in Traumatic Spinal Cord Injury

Alis J. Dicpinigaitis, School of Medicine, New York Medical College, Valhalla, New York, USA.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.Follow
Phillip O. Bempong, School of Medicine, Meharry Medical College, Nashville, Tennessee, USA.
Syed Faraz Kazim, Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA.
Jared B. Cooper, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Jose F. Dominguez, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Alan Stein, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Piyush Kalakoti, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Simon Hanft, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Jared Pisapia, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.Follow
Merritt D. Kinon, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.Follow
Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.
Meic H. Schmidt, Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA.
Christian A. Bowers, Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA.

Author Type(s)

Faculty, Resident/Fellow

DOI

10.1227/neu.0000000000002088

Journal Title

Neurosurgery

First Page

575

Last Page

582

Document Type

Article

Publication Date

10-1-2022

Department

Neurology

Second Department

Neurosurgery

Abstract

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), which was not present in younger age groups. CONCLUSION: Frailty is an independent predictor of clinical outcomes after tSCI, especially among patients of advanced age. Our large-scale analysis contributes novel insights into limited existing literature on this topic.

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