Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic
Authors' conclusion
In this study of 149 163 patients classified as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.
Study context
- Population
- Obese spine surgery patients ≥18 years, American College of Surgeons National Quality Improvement program database 2012–2020
- Participants
- 149,163 patients
- Exposure
- Discrimination of risk analysis index (RAI) vs mFI-5 vs patient age for postoperative mortality
- Outcome
- Postoperative mortality
Methodological detailsACS NSQIP database 2012–2020, ROC analysis, risk-adjusted proportional hazards regression
- ACS NSQIP database 2012–2020
- ROC analysis
- Risk-adjusted proportional hazards regression
Main finding
As reported in the abstract
RAI
0.793
C-statistic · 95% CI 0.773–0.813
mFI-5
0.671
C-statistic · 95% CI 0.650–0.691
Patient age
0.686
C-statistic · 95% CI 0.666–0.707
Observational data: associations, not effects.
Further findings
Risk-adjusted postoperative mortality by RAI frailty strata
- Typical patients, HR
- 2.55 (95% CI 2.03-3.19)
- Frail patients, HR
- 3.48 (95% CI 2.49-4.86)
- Very frail patients, HR
- 4.90 (95% CI 2.87-8.37)
- Stepwise increasing effect size across frailty strata
Postoperative mortality within Clavien-Dindo, frailty and obesity strata
- Increasing mortality effect sizes within CD complication strata, consistent across obesity categories, exponentially increasing with frailty, multiplicatively enhanced within CD, frailty and obesity strata
Original publication
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