RESUMEN
Introduction: Frailty is a term used to quantify the physiological age of patients. Higher levels of frailty correlate with higher complications and mortality rates after different surgical procedures. The objective of this work is to evaluate the relationship between frailty and the complications and mortality rates after elective spinal surgeries within 90 days. Material and Methods: A retrospective observational analytical study of patients older than 18 years with elective spine surgery was performed. The following variables were analyzed differentially according to their Modified Frailty Index (mFI) with a cut-off point of 0,18: age, sex, body mass index, ASA score, details of the procedures, length of stay, complications, unscheduled rehospitalizations, reoperations, and mortality within 90 postoperative days. Results: 257 patients were included. Within the 30 complications, 16 occurred in the non-frail group (8%) and 14 in frail patients (24.5%), (p = 0.02). Six complications were infectious in the group of frail patients (10.5%) and 4 in the non-frail patients (2%), (p = 0.009). No significant differences were detected regarding the duration of surgeries, the length of stay or the reoperations, re-hospitalizations or mortality rates. Conclusion: Patients with a modified Frailty Index ≥0,18 who underwent elective spine surgery were 3 times more likely to present complications, particularly, infectious ones.
Introducción: La fragilidad es un término utilizado para cuantificar la edad fisiológica de los pacientes. Niveles más altos de fragilidad se correlacionan con mayores tasas de complicaciones y mortalidad luego diferentes procedimientos quirúrgicos. El objetivo de este trabajo es evaluar la relación entre la fragilidad y la tasa de complicaciones y mortalidad posterior a cirugías columna electivas dentro de los 90 días. Material y Métodos: Se realizó un estudio analítico observacional retrospectivo de pacientes mayores de 18 años operados de manera electiva en su columna vertebral. Se analizaron las siguientes variables de manera diferencial según su Índice de Fragilidad modificado (IFm) con punto de corte en 0,18: edad, sexo, índice de masa corporal, score de ASA, detalles de los procedimientos, días de internación, complicaciones, reinternaciones, reoperaciones, y mortalidad dentro de los 90 días postoperatorios. Resultados: Se incluyeron 257 pacientes. De las 30 complicaciones, 16 ocurrieron en el grupo de los no frágiles (8%) y 14 a pacientes frágiles (24,5%), (p= 0,02). Seis complicaciones fueron infecciosas en el grupo de pacientes frágiles (10,5%) y 4 en los no frágiles (2%), (p= 0,009). No se detectaron diferencias significativas en cuanto a la duración de las cirugías, los días de internación, en la tasa de reoperaciones, reinternaciones ni en la mortalidad. Conclusión: Los pacientes operados electivamente de columna con un Índice de Fragilidad Modificado ≥0,18 presentaron una probabilidad 3 veces mayor de presentar complicaciones, particularmente infecciosas.
Asunto(s)
Fragilidad , Humanos , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
Spinal tuberculosis (Pott disease) can produce severe deformities when it is not properly treated. Long instrumentations through single or combined double approaches are usually required to prevent and correct the deformity. The authors present a case of severe deformity secondary to tuberculous spondylodiscitis in the lumbar spine treated with a monosegmental instrumentation through a double approach in a patient with idiopathic scoliosis. Deformity correction and infection resolution through debridement and arthrodesis is observed after one year of follow-up.
A tuberculose espinhal (doença de Pott) pode produzir deformidades severas se não for tratada adequadamente. Instrumentações longas através de uma abordagem simples ou dupla geralmente são necessárias para corrigir a deformidade. Os autores apresentam um caso de deformidade severa em região lombar secundária a espondilodiscite tuberculosa tratada com instrumentação monossegmentária por dupla abordagem em um paciente com diagnóstico inicial de escoliose idiopática. A cirurgia corretiva e a resolução da infecção através de debridamento e artrodese é observada após um ano de acompanhamento.