• Julius Dengler, Hussain Gheewala, Clayton N Kraft, Aldemar A Hegewald, Ralf Dörre, Oliver Heese, Rüdiger Gerlach, Steffen Rosahl, Bernd Maier, Ralf Burger, Sebastian Wutzler, Barbara Carl, Yu-Mi Ryang, Khanh Toan Hau, Gregor Stein, Jens Gulow, Ali Allam, Nehad Abduljawwad, Gerardo Rico Gonzalez, Ralf Kuhlen, Sven Hohenstein, Andreas Bollmann, and Michael Stoffel.
• Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany. julius.dengler@helios-gesundheit.de.
• Eur Spine J. 2024 Jan 1; 33 (1): 193019-30.

PurposeIn spine care, frailty is associated with poor outcomes. The aim of this study was to describe changes in frailty in spine care during the coronavirus disease 2019 (COVID-19) pandemic and their relation to surgical management and outcomes.MethodsPatients hospitalized for spine pathologies between January 1, 2019, and May 17, 2022, within a nationwide network of 76 hospitals in Germany were retrospectively included. Patient frailty, types of surgery, and in-hospital mortality rates were compared between pandemic and pre-pandemic periods.ResultsOf the 223,418 included patients with spine pathologies, 151,766 were admitted during the pandemic and 71,652 during corresponding pre-pandemic periods in 2019. During the pandemic, the proportion of high-frailty patients increased from a range of 5.1-6.1% to 6.5-8.8% (p < 0.01), while the proportion of low frailty patients decreased from a range of 70.5-71.4% to 65.5-70.1% (p < 0.01). In most phases of the pandemic, the Elixhauser comorbidity index (ECI) showed larger increases among high compared to low frailty patients (by 0.2-1.8 vs. 0.2-0.8 [p < 0.01]). Changes in rates of spine surgery were associated with frailty, most clearly in rates of spine fusion, showing consistent increases among low frailty patients (by 2.2-2.5%) versus decreases (by 0.3-0.8%) among high-frailty patients (p < 0.02). Changes in rates of in-hospital mortality were not associated with frailty.ConclusionsDuring the COVID-19 pandemic, the proportion of high-frailty patients increased among those hospitalized for spine pathologies in Germany. Low frailty was associated with a rise in rates of spine surgery and high frailty with comparably larger increases in rates of comorbidities.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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