P47. The association of patient frailty increased complication and readmission rates after lumbar spinal fusion surgery

BACKGROUND CONTEXT Frailty is a clinically relevant state that is often found in geriatric patients. Frail patients often have increased complications and mortality rates when undergoing invasive procedures such as lumbar spinal fusion, yet literature outlining the association between frailty and post-fusion complications is absent. As the prevalence of frail patients continues to grow, a thorough analysis of their perioperative characteristics and complications is necessary to guide the safest route of surgical care. PURPOSE Here, we utilize predictive analytics to evaluate the role of frailty on the postoperative course of lumbar spinal fusion patients. STUDY DESIGN/SETTING Retrospective cohort analysis using the 2010-2016 National Readmission Database. PATIENT SAMPLE Using the 2010-2016 National Readmission Database, we conducted a retrospective cohort analysis of 596,568 patients who received a lumbar spinal fusion procedure. From this cohort, 22,624 patients were found to be frail. OUTCOME MEASURES Postoperative complications, associated surgical costs, inpatient length of stay, and readmission at 30- and 90-days. METHODS Frail patients were identified using ICD-9 codes, ICD-10 codes, and the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. We used propensity score matching to obtain a group of 22,624 non-frail, one-to-one age and sex matched, control patients from the initial lumbar spinal fusion cohort for comparison. Data was collected for those readmitted within 30 and 90 days, and all patients with routine or elective follow-ups were excluded. Statistics were conducted using RStudio, and predictive algorithms were developed using generalized gaussian logistic regression models. Significance was determined by Welch Two Sample t-testing, Tukey multiple comparison of means, and Wald testing. RESULTS The average age of the frail cohort was 63.76 years, and the average age of the propensity matched control group was 63.67 years at the time of lumbar fusion. The percent of female patients in the frailty and control groups were 55.6% and 56.5% respectively. Fragile patients had significantly higher total charges associated with their primary lumbar fusion procedure ($207,347.00±200,717.30) compared to those in the control group ($122,202.80±99,937.70) (p CONCLUSIONS Frailty has a significant influence on the postsurgical course of patients receiving lumbar spinal fusion. Not only does patient frailty increase the frequency and number of readmissions, but it also seems to be correlated with an increase in postoperative complications. Further long-term research is required to truly understand the comprehensive effects of frailty on patients receiving spinal fusion. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.