Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age

Authors

Alexandria F. Naftchi, School of Medicine, New York Medical College, Valhalla, NY, USA.
John Vellek, School of Medicine, New York Medical College, Valhalla, NY, USA.
Julia Stack, Center for Speech, Language and Hearing Disorders, SUNY Cortland, Cortland, USA.
Eris Spirollari, School of Medicine, New York Medical College, Valhalla, NY, USA.
Sima Vazquez, School of Medicine, New York Medical College, Valhalla, NY, USA.
Ankita Das, School of Medicine, New York Medical College, Valhalla, NY, USA.
Jacob D. Greisman, School of Medicine, New York Medical College, Valhalla, NY, USA.
Zehavya Stadlan, School of Medicine, New York Medical College, Valhalla, NY, USA.
Omar H. Tarawneh, School of Medicine, New York Medical College, Valhalla, NY, USA.
Sabrina Zeller, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Jose F. Dominguez, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Merritt D. Kinon, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Syed Faraz Kazim, Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA.
Meic H. Schmidt, Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA.
Christian A. Bowers, Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA. CABowers@salud.unm.edu.

Author Type(s)

Student, Resident/Fellow, Faculty

Journal Title

Dysphagia

First Page

837

Last Page

846

Document Type

Article

Publication Date

6-1-2023

Department

Neurosurgery

Abstract

Frailty is a measure of physiological reserve that has been demonstrated to be a discriminative predictor of worse outcomes across multiple surgical subspecialties. Anterior cervical discectomy and fusion (ACDF) is one of the most common neurosurgical procedures in the United States and has a high incidence of postoperative dysphagia. To determine the association between frailty and dysphagia after ACDF and compare the predictive value of frailty and age. 155,300 patients with cervical stenosis (CS) who received ACDF were selected from the 2016-2019 National Inpatient Sample (NIS) utilizing International Classification of Disease, tenth edition (ICD-10) codes. The 11-point modified frailty index (mFI-11) was used to stratify patients based on frailty: mFI-11 = 0 was robust, mFI-11 = 1 was prefrail, mFI-11 = 2 was frail, and mFI-11 = 3 + was characterized as severely frail. Demographics, complications, and outcomes were compared between frailty groups. A total of 155,300 patients undergoing ACDF for CS were identified, 33,475 (21.6%) of whom were frail. Dysphagia occurred in 11,065 (7.1%) of all patients, and its incidence was significantly higher for frail patients (OR 1.569, p < 0.001). Frailty was a risk factor for postoperative complications (OR 1.681, p < 0.001). Increasing frailty and undergoing multilevel ACDF were significant independent predictors of negative postoperative outcomes, including dysphagia, surgically placed feeding tube (SPFT), prolonged LOS, non-home discharge, inpatient death, and increased total charges (p < 0.001 for all). Increasing mFI-11 score has better prognostic value than patient age in predicting postoperative dysphagia and SPFT after ACDF.

Recommended Citation

Naftchi, A. F., Vellek, J., Stack, J., Spirollari, E., Vazquez, S., Das, A., Greisman, J. D., Stadlan, Z., Tarawneh, O. H., Zeller, S., Dominguez, J. F., Kinon, M. D., Gandhi, C. D., Kazim, S. F., Schmidt, M. H., & Bowers, C. A. (2023). Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age. Dysphagia, 38 (3), 837-846. https://doi.org/10.1007/s00455-022-10505-6