Predicting postoperative complications in patients undergoing lumbar spinal fusion by using the modified five-item frailty index and nutritional status
Bone Joint J . 2020 Dec;102-B(12):1717-1722. doi: 10.1302/0301-620X.102B12.BJJ-2020-0874.R1.
TaeWook Kang 1, Si Young Park 1, Joon Suk Lee 1, Soon Hyuck Lee 1, Jong Hoon Park 1, Seung Woo Suh 1
- Lumbar degenerative disc diseases can be prevented via Vitamin D Receptor – many studies
- Low back pain 2X more likely if very low Vitamin D – meta-analysis Nov 2017
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- A Review of Vitamin D in Spinal Surgery: Deficiency Screening, Treatment, and Outcomes - June 2020  PDF
- Vitamin D Levels and 1-Year Fusion Outcomes in Elective Spine Surgery - Oct 2015 https://doi.org/10.1097/BRS.0000000000001041
- Association Between Vitamin D Deficiency and Outcomes Following Spinal Fusion Surgery: A Systematic Review - Nov 2016 https://doi.org/10.1016/j.wneu.2016.07.074
Aims: As the population ages and the surgical complexity of lumbar spinal surgery increases, the preoperative stratification of risk becomes increasingly important. Understanding the risks is an important factor in decision-making and optimizing the preoperative condition of the patient. Our aim was to determine whether the modified five-item frailty index (mFI-5) and nutritional parameters could be used to predict postoperative complications in patients undergoing simple or complex lumbar spinal fusion.
Methods: We retrospectively reviewed 584 patients who had undergone lumbar spinal fusion for degenerative lumbar spinal disease. The 'simple' group (SG) consisted of patients who had undergone one- or two-level posterior lumbar fusion. The 'complex' group (CG) consisted of patients who had undergone fusion over three or more levels, or combined anterior and posterior surgery. On admission, the mFI-5 was calculated and nutritional parameters collected.
Results: Complications occurred in 9.3% (37/396) of patients in the SG, and 10.1% (19/167) of patients in the CG. In the SG, the important predictors of complications were age (odds ratio (OR) 1.036; p = 0.002); mFI-5 (OR 1.026 to 2.411, as score increased to 1 ≥ 2 respectively; p = 0.023); albumin (OR 11.348; p < 0.001); vitamin D (OR 2.185; p = 0.032); and total lymphocyte count (OR 1.433; p = 0.011) . In the CG, the predictors of complications were albumin (OR 9.532; p = 0.002) and vitamin D (OR 3.815; p = 0.022).
Conclusion: The mFI-5 and nutritional status were effective predictors of postoperative complications in the SG, but only nutritional status was successful in predicting postoperative complications in the CG. The complexity of the surgery, as well as the preoperative frailty and nutritional status of patients, should be considered when determining if it is safe to proceed with lumbar spinal fusion.Spinal Fusion complications 2.2 X more likely if low Vitamin D – Dec 2020
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- Magnesium also reduces back pain