Biological age captures physiological deterioration better than chronological age and is amenable to interventions. Blood-based biomarkers have been identified as suitable candidates for biological ...age estimation. This study aims to improve biological age estimation using machine learning models and a feature-set of 60 circulating biomarkers available from the UK Biobank (n = 306,116). We implement an Elastic-Net derived Cox model with 25 selected biomarkers to predict mortality risk (C-Index = 0.778; 95% CI 0.767-0.788), which outperforms the well-known blood-biomarker based PhenoAge model (C-Index = 0.750; 95% CI 0.739-0.761), providing a C-Index lift of 0.028 representing an 11% relative increase in predictive value. Importantly, we then show that using common clinical assay panels, with few biomarkers, alongside imputation and the model derived on the full set of biomarkers, does not substantially degrade predictive accuracy from the theoretical maximum achievable for the available biomarkers. Biological age is estimated as the equivalent age within the same-sex population which corresponds to an individual's mortality risk. Values ranged between 20-years younger and 20-years older than individuals' chronological age, exposing the magnitude of ageing signals contained in blood markers. Thus, we demonstrate a practical and cost-efficient method of estimating an improved measure of Biological Age, available to the general population.
Investigate the differences in spine surgery cost for metabolic syndrome patients.
Included were patients ≥18 undergoing fusion. Patients were divided into cervical, thoracic, and lumbar groups based ...on their upper instrumented vertebrae (UIV). Metabolic syndrome patients (MetS) included those with body mass index >30, diabetes mellitus, dyslipidemia, and hypertension. Propensity score matching for invasiveness between non-MetS and MetS used to assess cost differences. Total surgery costs for MetS and non-MetS adult spinal deformity patients were compared. Quality-adjusted life years (QALYs) and cost per QALY for UIV groups were calculated.
A total of 312 invasiveness matched surgeries met inclusion criteria. Baseline demographics and surgical details included age 57.7 ± 14.5, 54% female, body mass index 31.1 ± 6.6, 17% anterior approach, 70% posterior approach, 13% combined approach, and 3.8 ± 4.1 levels fused. The average costs of surgery between MetS and non-Mets patients was $60,579.30 versus $52,053.23 (P < 0.05). When costs were compared between UIV groups, MetS patients had higher cervical and thoracic surgery costs ($23,203.43 vs. $19,153.43, $75,230.05 vs. $65,746.16, all P < 0.05) and lower lumbar costs ($31,775.64 vs. $42,643.37, P < 0.05). However, the average cost per QALY at 1 year was $639,069.32 for MetS patients and $425,840.30 for non-Mets patients (P < 0.05). At life expectancy, the cost per QALY was $45,456.83 versus $26,026.84 (P < 0.05).
When matched by invasiveness, MetS patients had an average 16.4% higher surgery costs, 50% higher costs per QALY at 1 year, and 75% higher cost per QALY at life expectancy. Further research is needed on the possible utility of reducing comorbidities in preoperative patients.
•Cost utility analysis of surgical treatment for ASD in different frailty states.•F and SF patients had lower Cost/QALY compared to non-frail patients at 2 years and life expectancy.•ASD surgery is a ...cost-effective treatment option in both NF and F/SF groups.
The aim of this study was to investigate the cost utility of treating non-frail versus frail or severely frail adult spinal deformity (ASD) patients. 79 surgical ASD patients >18 years with available frailty and ODI data at baseline and 2-years post-surgery (2Y) were included. Utility data was calculated using the ODI converted to the SF-6D. QALYs utilized a 3% discount rate to account for decline to life expectancy (LE). Costs were calculated using the PearlDiver database. ICER was compared between non-operative (non-op.) and operative (op.) NF and F/SF patients at 2Y and LE. When compared to non-operative ASD, the ICER was $447,943.96 vs. $313,211.01 for NF and F/SF at 2Y, and $68,311.35 vs. $47,764.61 for NF and F/SF at LE. Frail and severely frail patients had lower cost per QALY compared to not frail patients at 2Y and life expectancy, and had lower ICER values when compared to a non-operative cohort of ASD patients. While these results support operative correction of frail and severely frail patients, it is important to note that these patients are often at worse baseline disability, which is closely related to frailty scores, and have more opportunity to improve postoperatively. Furthermore, there may be a threshold of frailty that is not operable due to the risk of severe complications that is not captured by this analysis. While future research should investigate economic outcomes at extended follow up times, these findings support the cost effectiveness of ASD surgery at all frailty states.
A single-center retrospective cohort study.
The objective of this study was to assess the effects of patient height and pelvic incidence (PI) on age-adjusted alignment outcomes of surgical adult ...spinal deformity (ASD) patients.
Patient height and PI have yet to be evaluated for their individual effects on achieving age-adjusted alignment targets.
Surgical ASD patients were grouped by percentile (low: <25th; normative: 25th-75th; high: >75th) for height and PI. Correction groups were generated at postoperative follow-up for actual alignment compared with age-adjusted ideal values for pelvic tilt (PT), pelvic incidence minus lumbar lordosis mismatch (PI-LL), and sagittal vertical axis, and PI-adjusted ideal alignment values for sacral slope (SS), as derived from clinically relevant formulas. Means comparison tests assessed differences in rates of matching ideal alignment (±10 y threshold for age-adjusted targets; -7 to 5 degrees measured minus ideal for SS) across height and PI groups.
Breakdown of all included 198 patients by PI group: low (25%, 38±11 degrees), normative (50%, 57±5 degrees), high (25%, 75±7 degrees). Breakdown of patient height groups: low (25%, 1.52±0.04 m), normative (50% 1.64±0.05 m), and high (25%, 1.79±0.06 m). Overall, 29% of patients met postoperative age-adjusted alignment targets for PT, 23% for PI-LL, and 25% for sagittal vertical axis. Overall, 26% of patients met PI-adjusted SS alignment. There were no differences across patient height groups in rates of achieving adjusted alignment target (all P>0.05). Patients with high PI reached age-adjusted ideal alignment for PT at a lower rate (16%) than patients with normative (33%) or low PI (33%, P=0.056). Of patients that matched at least 1 ideal alignment target, those with high PI showed inferior preoperative to postoperative changes in EuroQol 5-dimension questionnaire as compared with normative and low PI patients (P=0.015).
Patients with high PI reached ideal postoperative age-adjusted PT alignment at a lower rate than patients with normative and low PI. Height had no impact on postoperative age-adjusted alignment outcomes. Current postoperative ideal alignment targets may warrant an adjustment to account for PI.
In the current value-based health care climate where spinal surgery is shifting to the ambulatory setting, factors influencing postoperative patient length of stay (LOS) have significance to both ...surgeons and hospital administrators. Underlying patient factors including the diagnosis of radiculopathy and myelopathy have not been investigated in this context.
Identify predictors extended LOS(E-LOS) between myelopathy(M), radiculopathy(R), and patients with both (MR).
Retrospective review of a single-center stereographic database.
A total of 718 surgical cervical spine patients.
Postoperative LOS, patient factors, preoperative HRQL, complications, predictors of E-LOS.
Surgical cervical spine patients ≥18yrs diagnosed with M or R primary diagnoses were isolated in the single-center Comprehensive Spine Quality Database (Quality). Patients were stratified by surgical approach: Anterior, Posterior or Combined. Top-quartile LOS values were labeled as extended. M and R patients were compared using chi-squared and independent samples t-tests, as appropriate. Univariate tests assessed differences in baseline patient-related and surgical data between M and R, and extended/non-extended LOS. Univariate/multivariate analyses were run to assess predictive factors of E-LOS in each diagnosis group. Regression with stepwise model selection was employed to explore factors potentially significant in predicting LOS.
A total of 718 patients (54.5 years, 41.1%F, 29.1kg/m2). Mean CCI score: 1.11. Within the cohort, 177 patients (24.7%) had a diagnosis of myelopathy, 383 (53.3%) radiculopathy, and 22% with a diagnosis of myeloradiculopathy. Patients with M primary diagnosis were significantly older (62.2 vs 49.8yrs, p<0.001) and had a greater CCI score (1.64 vs 0.82, p<0.001) when compared to R patients. By approach: 76.7% anterior (57.6% of M, 90.6%R, 64.6%MR; p<0.001), 16.4% (35%M, 6%R, 20.9%MR; p<0.001) posterior, 6.5% (6.8%M, 3.4%R, 13.9%MR; p<0.001) combined. Average LOS: M(3.8days), R(1.5 days), MR(2.9 days) p<0.001. LOS for anterior approach in each diagnosis was as follows, M: 2.21, R: 1.21, MR: 1.69 days, p<0.001. Meanwhile, posterior approach LOS, M:6.06, R:2.91, MR:5.0, p<0.001; combined approach M: 5.17, R: 6.23, MR: 5.59, P=0.881. A total of 195 patients were categorized as E-LOS (Avg: 5.87 days), 87 M, 43 R, 65 MR. Major surgical approach of E-LOS for M (60.9%) and MR (44.6%) was posterior; whereas R E-LOS patients majorly underwent anterior procedures (53.5%). Generalized linear regression modeling found that the following combination of factors predicted E-LOS in R patients (R2=0.736, p=0.003):BMI, durotomy, CCI, anterior and combined approaches, and cardiac complications. An additional model discovered the predictors of E-LOS in M patients (R2= 0.312, p<0.001): age, hypertension, CCI, anterior and combined approaches, intraoperative complications, neuro complications, ileus, and return to OR in 90 days. Lastly, the model for E-LOS in MR patients consisted of (R2 = 0.267, p=0.001): age, durotomy, BL EQ5D, hypertension, posterior and combined approaches and postoperative complications, specifically neuro.
Independent of surgical approach, patients with a primary diagnosis of myelopathy, though older aged and higher comorbidity profile, had consistently longer overall postop LOS when compared to radiculopathy or myeloradiculopathy patients. The heightened risk in myelopathy patients for extended LOS should be considered when determining admission status for patients undergoing cervical spine surgery.
This abstract does not discuss or include any applicable devices or drugs.
•Examined outcomes in spine fusion patients with a diagnosis of metabolic syndrome.•Patients were propensity score matched for total levels fused.•Patients with metabolic syndrome underwent more ...posterior and open surgeries.•Metabolic syndrome was an independent risk factor for postoperative complications.
Metabolic syndrome is a clustering of clinical findings defined in the literature including hypertension, high glucose, abdominal obesity, high triglyceride, and low high-density lipoprotein cholesterol levels. The purpose of this study was to assess perioperative outcomes in patients undergoing spine fusion surgery with (MetS) and without (no-MetS) a history of metabolic syndrome. Included: Patients ≥18 yrs old undergoing spine fusion procedures diagnosed with MetS components with BL and 1-year follow-up were isolated in a single-center database. Patients in the two groups were propensity score matched for levels fused. 250 spine fusion patients (58 yrs, 52.2%F, 39.0 kg/m2) with an average CCI of 1.92 were analyzed. 125 patients were classified with MetS (60.2 yrs, 52%F, CCI: 3.2). MetS patients were significantly older (p = 0.012). MetS patients underwent significantly more open (Met-S: 78.4% vs No-MetS: 45.6%, p < 0.001) and posterior approached procedures (Met-S: 60.8% vs No-MetS: 47.2%, p = 0.031). Mean operative time: 272.4 ± 150 min (MetS: 288.1 min vs. no-MetS: 259.7; p = 0.089). Average length of stay: 4.6 days (MetS: 5.27 vs no-MetS: 3.95; p = 0.095). MetS patients had more post-operative complications (29.6% vs. 18.4%; p = 0.038), specifically neuro (6.4% vs 2.4%), pulmonary (4% vs. 1.6%), and urinary (4.8% vs 2.4%) complications. Binary logistic regression analyses found that MetS was an independent risk factor for post-operative complications (OR: 1.865 1.030–3.375, p = 0.040). With longer surgeries and greater open-exposure types, MetS patients were at greater risk for complications, despite controlling for total number of levels fused. Surgeons should be aware of the increased threat to spine surgery patients with metabolic syndrome in order to optimize surgical decision-making.
Study Design:
This was a retrospective cohort study of a national dataset.
Purpose:
The purpose of this study was to consider the influence of frailty on the development of hospital-acquired ...conditions (HACs) in adult spinal deformity (ASD).
Summary of Background Data:
HACs frequently include reasonably preventable complications. Eleven events are identified as HACs by the Affordable Care Act. In the surgical ASD population, factors leading to HACs are important to identify to optimize health care.
Methods:
Patients 18 years and older undergoing corrective surgery for ASD identified in the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP). The relationship between HACs and frailty as defined by the NSQIP modified 5-factor frailty index (mFI-5) were assessed using χ
2
and independent sample
t
tests. The mFI-5 is assessed on a scale 0–1 not frail (NF): <0.3, mildly frail (MF): 0.3–0.5, and severely frail (SF): > 0.5. Binary logistic regression measured the relationship between frailty throughout HACs.
Results:
A total of 9143 ASD patients (59.1 y, 56% female, 29.3 kg/m
2
) were identified. Overall, 37.6% of procedures involved decompression and 100% fusion. Overall, 6.5% developed at least 1 HAC, the most common was urinary tract infection (2.62%), followed by venous thromboembolism (2.10%) and surgical site infection (1.88%). According to categorical mFI-5 frailty, 82.1% of patients were NF, 16% MF, and 1.9% SF. Invasiveness increased with mFI-5 severity groups but was not significant (NF: 3.98, MF: 4.14, SF: 4.45,
P
>0.05). Regression analysis of established factors including sex odds ratio (OR): 1.22; 1.02–146;
P
=0.030, diabetes mellitus (OR: 0.70; 0.52–0.95;
P
=0.020), total operative time (OR: 1.01; 1.00–1.01;
P
<0.001), body mass index (OR: 1.02; 1.01–1.03;
P
=0.008), and frailty (OR: 8.44; 4.13–17.26;
P
<0.001), as significant predictors of HACs. Overall, increased categorical frailty severity individually predicted increased total length of stay (OR: 1.023; 1.015–1.030;
P
<0.001) and number of complications (OR: 1.201; 1.047–1.379;
P
=0.009).
Conclusions:
For patients undergoing correction surgery for ASD, the incidence of HACs increased with worsening frailty score. Such findings suggest the importance of medical optimization before surgery for ASD.
Persistent lumbopelvic malalignment following ASD-corrective surgery may impair quality of life and result in persistent pathologic compensation in the lower extremities. Patient-specific age- and ...BMI-adjusted alignment targets have been proposed to improve alignment outcomes; however, it is unclear whether reaching these postop targets reduces rates of pelvic nonresponse following surgery.
Assess the relationship between pelvic nonresponse to ASD-corrective surgery and persistent lower-extremity compensation.
Single center retrospective review.
Fifty-eight ASD patients.
Sagittal alignment.
Included: surgical ASD patients with full-spine X-ray imaging at pre- and early postop follow-up (<1Y). Patients were grouped by postop improvement in PT, per SRS-Schwab Classification: those who did not improve (pelvic nonresponders, PNR), and those that did improve (pelvic responders, PR). Groups were propensity score matched for preop PT, and assessed for differences in demographics, surgical factors, and alignment (sagittal spinal and lower extremity) with means comparison tests. Rates of persistent postop lower extremity compensation (defined as no improvement in lower extremity alignment) were compared between groups. Subanalysis assessed the relationship between reaching postop age- and BMI-specific alignment targets and rates of pelvic nonresponse.
Following propensity score matching, PNR (N=29) and PR (N=29) patients did not differ in age, sex, BMI or preop sagittal spinal alignment (all p>0.05); however, PNR patients presented with less knee flexion (9° vs 14°, p=0.043). Groups did not differ in levels fused (10.8 vs 10.8, p=0.974) or osteotomy (93% vs 92%, p=0.902). Postop, PNR patients had inferior lumbopelvic alignment in PT (30° vs 17°), PI-LL (17° vs 3°), and greater global malalignment for TPA (27° vs 15°, all p<0.001). For PNR patients, these changes in alignment were accompanied by greater compensatory anterior hip extension (53mm vs 31mm, p=0.021). PNR patients also showed greater pre- to postop increases in sacrofemoral angle (2° vs −5°), and smaller decreases in hip extension (−24mm vs −64mm), pelvic femoral angle (−1.4° vs −3.8°), and global sagittal angle (−3.5° vs −8°, all p<0.005), indicating persistent lower extremity compensation. PNR patients had higher rates of persistent postop lower extremity compensation for sacrofemoral angle (68% vs 25%), ankle flexion (64% vs 33%), and pelvic shift (28% vs 4%, all p<0.034). PNR and PR groups did not differ in rates of reaching age- and BMI specific ideal postop alignment for PT, SVA, TPA, or PI-LL (all p>0.05). For patients with severe preop SVA deformity, overcorrection relative to ideal postop PT targets was associated with lower rates of pelvic non-response (under: 12%, match: 18%, over: 71%, p<0.001). Lower rates of nonresponse were observed for patients with severe preop PT deformity overcorrected relative to ideal postop PI-LL (under: 0%, match: 30%, over: 70%, p=0.016).
Pelvic nonresponders following ASD-corrective surgery had higher rates of persistent compensatory action in the lower extremities. Patients with severe preop PT deformity who were surgically overcorrected with respect to ideal PI-LL had lower rates of postop pelvic nonresponse, indicating that for severely malalignmed patients, existing alignment targets may need to be adjusted to optimize alignment outcomes.
This abstract does not discuss or include any applicable devices or drugs.
The Adult Spinal Deformity Frailty Index (ASD-FI), a validated modality for quantifying frailty, stratifies patients into categories not frail (NF), frail (F) and severely frail (SF). However, the ...cost of treating each frailty state is unknown.
Investigate the cost utility of treating not frail versus frail or severely frail ASD patients.
Retrospective review of a prospective single center adult spinal deformity database.
A total of 79 operative and non operative ASD patients ≥18 years old, with baseline and 2Y ASD-FI and Oswestry Disability Index (ODI) scores.
ODI, SF-6D, Cost per quality adjusted life years (QALY), Incremental Cost Effectiveness, Ratio (ICER).
Inclusion criteria was surgical ASD (scoliosis≥20°, SVA≥5cm, PT≥25°, or thoracic kyphosis ≥60°) patients >18 years with available frailty and ODI data at BL and 2-years post op. Independent T-Tests assessed baseline radiographic differences in PT, PI-LL, and Schwab SVA modifier status between NF vs. F/SF patients. Utility data was calculated using the ODI converted to the SF-6D using published conversion methods. QALYs utilized a 3% discount rate to account for residual decline to life expectancy (78.7 years). Costs were calculated using the PearlDiver database. After accounting for complications, LOS, revisions, and death, cost per QALY at 2Y and life expectancy were calculated for NF, and F/SF patients. ICER was compared between non op and operative NF and F/SF patients at 2Y and life expectancy.
Seventy-nine ASD patients met inclusion criteria. Descriptive statistics for the cohort were: age 51.0±6.8, 76% women, BMI 26.7±6.8, 54% osteotomy, 54% decompression, and 11.6±4.2 average levels fused. At BL, there were 48 NF, 26 F, and 4 SF pts. The average BL frailty for NF pts was 0.13±0.08, 0.39±0.06 for F, and 0.59±0.08 for SF pts. There were no differences in PT, PI-LL, or severe SVA Schwab modifier grades between NF or F/SF pts (all p>0.05). At 2-year follow up, there was no difference in the average cost of ASD surgery, $91,068.98 for NF patients and $90,888.53 for F/SF pts (p>0.05). The cost per QALY was higher for NF pts at 2 years vs F/SF pts ($464,239.62 vs. $321,107.89, p<0.05). If the utility gained was sustained to life expectancy, the cost per QALY was $70,796.43 for NF and $48,968.88 for F/SF (p<0.05). When compared to non op ASD pts, the ICER was $447,943.96 vs. $313,211.01 for NF and F/SF at 2 years, and $68,311.35 vs. $47,764.61 for NF and F/SF at life expectancy.
Frail and severely frail patients had lower cost per QALY compared to not frail patients at 3 years and life expectancy. In addition, when compared to a non operative cohort of ASD patients, frail and severely frail patients had lower ICER values. While these results support operative correction of frail and severely frail patients, it is important to note that these patients are often at worse baseline disability, which is closely related to frailty scores, and have more opportunity to improve postoperatively. In addition, there may be a threshold of frailty that is not operable due to the risk of severe complications that is not captured by this analysis. While future research should investigate economic outcomes at extended follow-up times, these findings support the cost effectiveness of ASD surgery at all frailty states.
This abstract does not discuss or include any applicable devices or drugs.
The Roussouly Classification system of sagittal spinal shape and the SRS-Schwab adult spinal deformity (ASD) classification system have become important indicators of spine deformity. No prior ...studies have examined the outcomes of matching both Roussouly type and improving in Schwab modifiers postoperatively.
Evaluate outcomes of matching Roussouly Type and improving in Schwab modifier following ASD surgery.
Retrospective review of single-center ASD database.
A total of 103 ASD patients.
Roussouly types, Schwab modifiers, Health Related Quality of Life scores(HRQLs): Minimal Clinical Important Difference for ODI, EQ5D, VAS Leg &Back Pain.
Surgical ASD patients (SVA≥5cm, PT≥25°, or TK ≥60°, >3 levels fused) ≥18 years old with available baseline (BL) radiographic data at baseline (BL) and 1-year (1Y) were isolated in the single-center Comprehensive Spine Quality Database (Quality). Patients were grouped by two Roussouly types: (1)“theoretical” Roussouly type(Type 1: PI<45°, LL apex below L4; Type 2: PI<45°, LL apex above L4 L4-L5 space; Type 3: 45°<PI<60°; Type 4: PI>60°); (2) “current” Roussouly type (1: SS<35°, LL apex below L4; 2: PI<35°, LL apex above L4-L5 space; 3: 35°<PI<45°; 4: PI>45°), as previously published. One year (1Y) matched Roussouly: preoperative mismatched (Between ‘actual’ and ‘theoretical’ patients that matched at 1Y. Schwab modifiers at BL were identified: non-, moderate and severe deformity (0, +, ++) for PT, SVA, and PI-LL. Schwab improvement was defined as a decrease in a modifier at one year.
A total of 103 ASD patients (61.8yrs, 63.1%F, 30kg/m2). By surgical approach, 79.6% posterior, 10.7% combined, 2.9% anterior). Average levels fused: 4.6. BL breakdown of ‘current; Roussouly type: 28% Type 1, 25.3% Type 2, 32.0% Type 3, 14.7% Type 4. BL Roussouly mismatch: 65.3%. Breakdown BL Schwab modifiers: PT (0: 8.7%, +: 41.7%, ++: 49.5%), SVA (0: 29.7%, +: 20.3%, ++: 50%), PI-LL mismatch (0: 28.2%, +: 25.2%, ++: 46.6%). At one year, 19.2% of patients matched Roussouly target type, while according to Schwab modifiers, 12.6% improved in SVA, 42.7% in PI-LL, and 45.6% in PT. Patients who both met Roussouly type and improved in a Schwab by the modifiers: 9 PT (8.7%), 8 PI-LL (7.8%), 2 SVA (1.9%). There were 2 patients (1.9%) who met their Roussouly type and improved in all 3 Schwab modifiers. One year (1Y) matched Roussouly patients improved more in HRQLs (MCID for ODI, EQ5D, VAS Leg/Back Pain), when compared to mismatched Roussouly, but was not significant(P>0.05). Match Roussouly and improvement in PT Schwab met MCID for EQ5D significantly more (33.3% vs 10.6%, p=0.050). Matched Roussouly and PI-LL Schwab had more patients meet MCID for all HRQLs, yet none were significant, p>0.05. Matched Roussouly and improvement in SVA Schwab met MCID for ODI significantly more (p=0.024).
Patients who both matched Roussouly sagittal spinal type and improved in SRS-Schwab modifiers had superior patient-reported outcomes at 1-year. Utilizing both classification systems in surgical decision making can optimize postop patient outcomes.
This abstract does not discuss or include any applicable devices or drugs.
