Severe Frailty is an Independent Predictor of Mortality in Complete Spinal Cord Injury: A Population-Wide 15 Year Follow-Up Retrospective Study

Wednesday, February 21, 2024

Presenting Author(s)

Kelly Jiang, n/a

Medical Student
Johns Hopkins University School of Medicine
Baltimore, MD, US

Co-Author(s)

KA

Kimberly Ashayeri, MD

Neurosurgery Spine Fellow
Johns Hopkins University School of Medicine
New York, NY, US
Daniel Davidar, MD

Research Fellow
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Andrew M. Hersh, B.S.

Medical Student
John Hopkins Medical School
Baltimore, MD, US
Nicholas Theodore, MD, MS (he/him/his)

Director, Neurosurgical Spine Center; Professor of Neurosurgery
Johns Hopkins University School of Medicine
Baltimore, MD, US
Carly Weber-Levine, MS (she/her/hers)

Medical Student
Johns Hopkins University School of Medicine
East Setauket, NY, US

Disclosure(s):

Andrew M. Hersh, AB: No financial relationships to disclose

Carly Weber-Levine, MS: No financial relationships to disclose

Introduction: Frailty is a known correlate of poor outcomes after surgery. However, frailty is not well-studied in patients with spinal cord injury (SCI) as most tend to be young and male. This study examines the effect of frailty on mortality in patients with complete SCI across 15 years of post-injury follow-up time.

Methods: TriNetX Research Network, a national federated health network, was queried by ICD10 code for patients with complete SCI in the cervical, thoracic, or lumbar regions. Frailty was defined by the modified 5-item frailty index (mFI). Patients were propensity score matched to control for age and sex. Kaplan-Meier plots were used to evaluate survival differences between severely frail patients (mFI >=3) and non-frail patients (mFI < 3).

Results: Of the 27,527 patients with complete SCI identified, 6,194 were cervical, 8,268 were thoracic, and 13,065 were lumbar injuries. MFI >=3 was observed in 32.6% of cervical injuries, 26.6% of thoracic injuries, and 38.1% of lumbar injuries. Severe frailty was an independent predictor of mortality for all three regions (Cervical: HR 1.561, 95%CI 1.326-1.837, p< 0.0001; Thoracic: HR 1.822, 95%CI 1.562-2.124, p< 0.0001; Lumbar: 1.27, 95%CI 1.177-1.369, p< 0.0001). Severely frail patients with complete SCI experienced up to 7.4 years of decreased median survival.

Conclusion : Severe frailty independent of age and sex is a predictor of mortality in patients with complete SCI regardless of injury location. Frailty is the greatest predictor of mortality in patients with thoracic injuries, where severely frail patients are nearly twice as likely to die. While frailty is often associated with immediate post-operative complications and mortality, this study demonstrates that it is also a predictor of long-term outcomes in patients with complete SCI.