학술논문
Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age.
Document Type
Academic Journal
Author
Naftchi AF; School of Medicine, New York Medical College, Valhalla, NY, USA.; Vellek J; School of Medicine, New York Medical College, Valhalla, NY, USA.; Stack J; Center for Speech, Language and Hearing Disorders, SUNY Cortland, Cortland, USA.; Spirollari E; School of Medicine, New York Medical College, Valhalla, NY, USA.; Vazquez S; School of Medicine, New York Medical College, Valhalla, NY, USA.; Das A; School of Medicine, New York Medical College, Valhalla, NY, USA.; Greisman JD; School of Medicine, New York Medical College, Valhalla, NY, USA.; Stadlan Z; School of Medicine, New York Medical College, Valhalla, NY, USA.; Tarawneh OH; School of Medicine, New York Medical College, Valhalla, NY, USA.; Zeller S; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.; Dominguez JF; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.; Kinon MD; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.; Gandhi CD; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.; Kazim SF; Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA.; Schmidt MH; Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA.; Bowers CA; Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA. CABowers@salud.unm.edu.
Source
Publisher: Springer-Verlag Country of Publication: United States NLM ID: 8610856 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0460 (Electronic) Linking ISSN: 0179051X NLM ISO Abbreviation: Dysphagia Subsets: MEDLINE
Subject
Language
English
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.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)