P152. The effect of frailty on outcome after traumatic spinal cord injury.

Frailty, defined as a state of decreased reserve and susceptibility to external stressors, has previously been shown to negatively effect postoperative outcome in an elective spine surgery population. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). This prospective cohort study took place at a single quaternary spinal referral center. A total of 634 patients. Inpatient length of stay, in-hospital mortality, adverse events. All patients with tSCI were identified in our prospectively collected database from 2007-2016. Analysis was conducted to examine correlations between patient age, total motor score (TMS) on admission, and mFI on patient outcome variables including acute length of stay (LOS), number of adverse events (AEs) and in-hospital mortality. Bivariate analysis revealed multiple statistically significant associations. mFI was a strong predictor of increased acute LOS (corr =0.163; p<.0001), number of AEs (corr=0.1664; p<.0001) and in-hospital mortality (corr=0.155; p<.0001). Age at injury was also significantly correlated with acute LOS (corr=0.0809; p=0.0418), number of AEs (corr=0.0937; p=0.0231) and in-hospital mortality (corr=0.2639; p<.0001). Lastly, motor score on admission was also predictive of acute LOS (corr=-0.4749; p<.0001), number of AEs (corr=-0.3069; p<.0001), and in-hospital mortality (corr=-0.2249; p<.0001). Subgroup analysis was then performed on patients aged >65 years. Mean frailty index was not predictive of acute LOS (p=0.1533), number of AEs (p=0.2337) or in-hospital mortality (p=0.6593). Age at injury was not predictive of acute LOS (p=0.0571), however remained significant for number of AEs (p=0.0058), and in-hospital mortality (p<.0001). This was also true for motor score on admission, which was predictive of acute LOS (p<.0001), number of AEs (p=.0038) and in-hospital mortality (p<.0001). Age, mFI and TMS on admission are important determinants of outcome in patients with tSCI. Furthermore, frailty score is predictive of outcome in the general tSCI population, but not in the elderly. This suggests that younger, "frail" individuals have significantly poorer outcomes than young, healthy individuals, however the inter-relationship between advanced age and decreased physiologic reserve is not as clear. Identification of frailty in a younger population as a pre-injury risk factor may be useful for perioperative optimization, risk stratification and patient counseling. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]