Changes in frailty among patients hospitalized for spine pathologies during the COVID-19 pandemic in Germany—a nationwide observational study

Purpose In 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. Methods Patients 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. Results Of 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. Conclusions During 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.