Is Frailty Discouraging Surgeons from Performing Thoracolumbar Fusion? A Retrospective Study

Study Design. Retrospective cohort study. Objective. To evaluate whether frailty scoring is associated with adverse outcomes and management of thoracolumbar fractures (TLF) patients. Summary of background data. Trauma patients with TLF often face longer recovery. The Canadian Study of Health and Aging clinical frailty scale (CSHA-CFS) predicts outcomes in older trauma patients. Methods. Adult trauma patients admitted from 2017 to 2021 who presented with TLF were included. Frailty was scored using CSHA-CFS. Endpoints were in-hospital mortality, hospital length of stay, surgery, complications, and discharge disposition. Multivariate analyses adjusting for baseline characteristics were performed. P <0.05 was considered significant. Results. Overall, 1456 patients were included; 1013 fit, 240 pre-frail, and 203 frail. Frail patients underwent fewer surgeries (OR=0.5 [0.32-0.77], P =0.002). TL fusion was associated with lower mortality (OR=0.31 [0.11-0.85], P =0.024). Pre-frailty and frailty were associated with increased risk of pneumonia (OR=2.522 [1.428-4.456], P =0.001; OR=2.93 [1.32-6.54], P =0.008, respectively) and death (OR=3.581 [1.853-6.921], P <0.001; OR=2.46 [1.07-5.67], P =0.035). Pre-frail and frail patients were more likely to discharge to skilled nursing facilities (OR=1.687 [1.024-2.780], P =0.04; OR=4.89 [2.66-9.0]), P <0.001). Conclusions. Pre-frailty and frailty were associated with poor outcomes and higher level of care at discharge. Frail patients were less likely to undergo TL fusion, despite its association with improved survival. This suggests frailty should not discourage surgeons from performing thoracolumbar fusion. Frailty scoring upon admission may help guide management and set realistic expectations for patients and their families.