53. The influence of frailty on PJF: is optimal realignment superseded by physiologic age?

Patients receiving surgery for adult spinal deformity (ASD) are often frail and may be at risk of adverse events following these intensive procedures, including proximal junctional failure (PJF). The role of physiologic age in prognosticating this outcome is not well define To determine if the benefits of optimal realignment on PJF development can be negated by increasing frailty as determined by physiologic age. Retrospective cohort study of prospective, multicenter ASD database A total of 245 ASD patients. Complications. Complications A total of 245ASD patients met inclusion criteria (57yrs±15.0, 82%F, BMI: 26.3 kg/m2 ±6.0, ASD-FI: 2.9±1.6, CCI: 1.55 ±1.7). Surgical patients had a mean levels-fused of 11.4±4, LOS of 7.7 days±4.4, EBL of 1686 mL, operative time of 374 min, with 70% undergoing an osteotomy. In terms of surgical approach, 76% were posterior-only and 23.6% had a combined approach. Of the 245 patients, 138 (55%) of patients were characterized as not frail, 107 (43%) as frail. Overall rate for PJK was 49%, and 12% for PJF. The presence of PJF in the NF group was lower than in the F group, (7% vs 18%; p<0.05). Controlling for age, BL deformity and surgical invasiveness, a higher BL frailty index was correlated with increased odds of developing PJF (OR: 1.4, 95% CI: 1.01-1.9) and the risk of developing PJF for F vs NF patients was 3x higher (OR: 3 95% CI: 1.3-7). Controlling for BL deformity and invasiveness, patients matched in SVA still developed PJF with a high frailty index (OR: 1.7, 95% CI: 1.02-2.8, p=.014). CIT found patients with a frailty index greater than 3.4 had a 2.5x higher likelihood of developing PJF (OR: 2.5, 95% CI: 1.14-5.5, p=.026) and, in a cohort of patients matched in SVA, a frailty index higher than 4.9 led to a 5x higher likelihood of developing PJF (OR: 5, CI: 1.2-20, both p<0.05) Frailty is a significant independent predictor of PJF development, and while optimizing realignment may minimize this effect, frailty still remains a risk factor. The alarmingly high rates of PJF despite adequate alignment in frail patients warrants further research to determine whether operating on very frail patients with large deformity is advisable. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]