Resident Rush University Medical Center Chicago, IL, US
Disclosure(s):
Adewale A. Bakare, MD: No financial relationships to disclose
Introduction: There are limited studies assessing predictors of perioperative adverse events (AEs) following atlanto-axial fusion (AAF) and/or occipito-cervical fusion (OCF). Thus, we compared the ability of modified frailty index-11 (mFI-11) and Charlson comorbidity index (CCI) to predict AEs.
Methods: 219 adult patients without prior surgery who underwent AAF or OCF between 2009 and 2023 were identified in this retrospective study. Perioperative AE analyzed were major complication, non-home discharge, and prolonged length of stay (LOS). Univariate and multivariable analyses, as well as Receiver operating characteristic (ROC) curve, were used to determine which index best predict these AEs.
Results: The median age was 71.5 years with majority (45.2%) aged 60-69 years and female (60.7%). The median LOS was 6 days with 27.4% staying > 10 days while 16.9% had major complications and 37.4% were discharged to rehabilitation. The median mFI-11 was 1, with majority of patients (32.4%) scoring 1 while the median CCI was 4, with majority (38.4%) scoring > 5. In the multivariable analysis, neither risk index predicted major complication or prolonged LOS. However, mFI-11 was associated with increased odds of non-home discharge (OR:1.8, p=0.003) while CCI was associated with small but decreased odds of non-home discharge (OR:0.8, p=0.027). Both the mFI-11 and CCI showed modest but closely similar predictive ability for major complications (AUC=0.633 versus 0.636). mFI-11 had slightly stronger discriminative ability (AUC=0.645 versus 0.602) in predicting non-home discharge. CCI is a slightly better predictor of prolonged LOS (AUC=0.597 versus 0.576), but neither was strongly predictive.
Conclusion : Neither risk index strongly predicted major complications or prolonged LOS, though mFI-11 was associated with increased odds of non-home discharge while CCI showed a modest association with lower odds. Both indices had fair and similar predictive abilities for major complications, but mFI-11 is slightly better for predicting non-home discharge. Overall, neither index showed strong predictive value for prolonged LOS.