The Influencing Factors of Frailty and Quality of Life in Elderly Patients After Spinal Surgery

Figures & data

Table 1 Incidence of Frailty at Different Time Points (n, %)

	POD-30	POD-90
Non-frailty group[cases (%)]	66(64.7)	89(88.1)
Frailty group[cases (%)]	36(35.3)	12(11.9)

Abbreviations: POD-30, the 30th day after operation; POD-90, the 90th day after operation.

Figure 1 Incidence of frailty at different time points. The chi-square test and Fisher’s exact test were used to compare the incidence of frailty between groups.

Abbreviations: POD-30, the 30th day after operation; POD-90, the 90th day after operation.

Table 2 Preoperative Analysis of Related Factors in the Two Groups of Patients (, %)

Index	Non-Frailty Group (n=66)	Frailty Group (n=36)	P-value
Age (years)	69.55±4.11	71.42±5.07	0.046
Gender [cases (%)]
Male	29(43.9)	15(41.5)	0.825
Female	37(56.1)	21(56.9)
BMI (kg/m^2)	22.8±2.90	24.42±3.73	0.028
Ethnicity [cases (%)]
Han nationality	45(68.2)	23(63.9)	0.660
Ethnic minorities	21(31.8)	13(36.1)
Hypertension [cases (%)]
YES	26(39.4)	13(36.1)	0.744
NO	40(60.6)	23(63.9)
Diabetes[cases (%)]
YES	7(10.6)	4(11.1)	1.000
NO	59(89.4)	32(88.9)
Coronary heart disease[cases (%)]
YES	4(6.1)	6(16.7)	0.160
NO	62(93.9)	30(83.3)
Anxiety[cases (%)]
YES	17(25.8)	6(16.7)	0.294
NO	49(74.2)	30(83.3)
Depression[cases (%)]
YES	8(12.1)	6(16.7)	0.524
NO	58(87.9)	30(83.3)
Preoperative Hb (g/L)	126.86±17.73	130.16±16.78	0.362
Preoperative ALB (g/L)	42.2(39.9, 43.2)^a	40.7(38.0, 41.9)^a	0.023

Notes: ^aData described as median (P25, P75); Except for the preoperative ALB level, which was expressed as the median (P25, P75), and the chi-square test was applied for between-group comparisons, all other data were expressed as the mean ± standard deviation, and the two-sample t-test was applied for comparison between groups. P<0.05 indicated that the difference was statistically significant.

Abbreviations: BMI, body mass index; ALB, serum albumin level.

Table 3 Comparison of NRS Scores Between the Two Groups at Different Times M (P25, P75)

	NRS Score
	POD-1	POD-3	POD-30
Non-frailty group	(2,4)*	(2,3)	(0,2)
Frailty group	(2.25,6)	(2,3)	(0,3)
Z	−2.846	−1.291	−1.232
P	0.004	0.197	0.218

Notes: Applying the Mann–Whitney U-test for analysis. Compared with the frail group at the same time point, *P < 0.05.

Abbreviations: POD-1, the 1st day after operation; POD-3, the 3rd day after operation; POD-30, the 30th day after operation; NRS, Numeric rating scale.

Table 4 Multivariate Logistic Regression Analysis of Frailty (n=102)

Independent variable	β	SE	Wald χ^2	P	OR	95% CI
Constant	−12.878	5.453	5.577	0.018	<0.001
Age	0.149	0.055	7.427	0.006	1.161	1.043~1.293
BMI	0.180	0.075	5.772	0.016	1.197	1.034~1.387
Preoperative ALB	−0.102	0.067	2.297	0.130	0.903	0.792~1.030
NRS on POD-1	0.474	0.147	10.422	0.001	1.607	1.205~2.143

Note: P<0.05 was considered statistically significant.

Abbreviations: BMI, body mass index; ALB, serum albumin level; NRS, Numeric rating scale; POD-1, the 1st day after operation.

Figure 2 Frailty-related risk factors analysis. Logistic multivariate regression analysis was applied to analyze the risk factors associated with frailty, and the results showed that Age, BMI, and NRS₁ were independent risk factors for postoperative frailty (P<0.05).

Abbreviations: BMI, body mass index; NRS, Numeric rating scale; NRS1, the NRS score on the first day after surgery.

Table 5 Comparison of EQ-5D-5L Scores Between the Two Groups at Different Times ()

	EQ-5D-5L
	DAY-0	POD-30	POD-90
Non-frailty group	9.89±3.43*	6.95±2.69^a*	5.94±1.75^ab*
Frailty group	11.11±3.98	11.61±4.37	9.28±4.60^ab

Notes: F _time = 21.100, P _time < 0.001; F _group = 43.382, P _group < 0.001; F _group×time = 6.943, P _group×time = 0.001; Compared with DAY-0 in the same group, ^aP < 0.05; Compared with POD-30 in the same group, ^bP < 0.05; Compared with the frail group at the same time point, *P < 0.05.

Abbreviations: DAY-0, 1 day before surgery; POD-30, the 30th day after operation; POD-90, the 90th day after operation; EQ-5D-5L, European five-dimensional health scale.

Figure 3 Comparison of EQ-5D-5L scores between the two groups at different time points. Repeated-measures ANOVA was applied to compare the differences in EQ-5D-5L scores between the two groups of patients at different time points.

Abbreviations: DAY-0, 1 day before surgery; POD-30, the 30th day after operation; POD-90, the 90th day after operation; EQ-5D-5L, European five-dimensional health scale.

Table 6 Correlation Analysis of EQ-5D-5L Scores 30 Days After Surgery (n=102)

Variable	r	P
Age	0.245*	0.013
Gender	−0.017	0.863
BMI	0.145	0.147
Ethnicity	−0.065	0.513
Hypertension	−0.026	0.793
Diabetes	0.118	0.236
Coronary heart disease	0.073	0.465
Preoperative GAD-7 score	0.126	0.208
Preoperative PHQ-9 score	0.217*	0.028
Preoperative Hb	0.065	0.518
Preoperative ALB	−0.274**	0.006
ASA classification	0.063	0.526
Surgical classification	−0.057	0.570
Anesthesia method	−0.075	0.451
Surgery time	0.038	0.707
Anesthesia time	0.031	0.756
Recovery time	0.047	0.641
Bleeding loss	0.079	0.432
NRS score on POD-1	0.142	0.154
NRS score on POD-3	0.016	0.871
NRS score on POD-30	0.063	0.532

Notes: *At 0.05 level (two-tailed), the correlation was significant; **At 0.01 level (two-tailed), the correlation was significant. P<0.05 was considered statistically significant.

Abbreviations: EQ-5D-5L, European five-dimensional health scale; BMI, body mass index; GAD-7, Anxiety screening scale; PHQ-9, Depression screening scale; ALB, serum albumin level; NRS, Numeric rating scale; POD-1, the 1st day after operation; POD-3, the 3rd day after operation; POD-30, the 30th day after operation.

Table 7 Multiple Linear Regression of EQ-5D-5L at 30 Days After Surgery (n=102)

Variable	Standard Error	P
(constant)	7.098	0.561
Age	0.084	0.011
Preoperative PHQ-9 score	0.118	0.323
Preoperative ALB	0.099	0.007

Note: P<0.05 was considered statistically significant.

Abbreviations: EQ-5D-5L, European five-dimensional health scale; PHQ-9, Depression screening scale; ALB, serum albumin level.

Data Sharing Statement

The datasets generated and analyzed during the current study are not publicly available due to limitations of ethical approval involving the patient data and anonymity but are available from the corresponding author upon reasonable request.