TY - JOUR
T1 - Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Length of Stay After Spine Surgery
AU - De la Garza Ramos, Rafael
AU - Goodwin, C. Rory
AU - Jain, Amit
AU - Abu-Bonsrah, Nancy
AU - Fisher, Charles G.
AU - Bettegowda, Chetan
AU - Sciubba, Daniel M.
N1 - Publisher Copyright:
© 2016
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objective The aim of this study was to develop a perioperative metastatic spinal tumor frailty index (MSTFI) that could predict morbidity, mortality, and length of stay. Methods A large inpatient hospitalization database was searched from 2002 to 2011 to identify 4583 patients with spinal metastasis from breast (21.1%), lung (34.1%), thyroid (3.8%), renal (19.9%), and prostate (21.1%) cancer who underwent surgery. A multiple logistic regression model identified 9 independent parameters that were used to construct the MSTFI: anemia, chronic lung disease, coagulopathy, electrolyte abnormalities, pulmonary circulation disorders, renal failure, malnutrition, emergent/urgent admission, and anterior/combined surgical approach. Patients with 0 points were categorized as “not frail,” 1 as “mildly frail,” 2 as “moderately frail,” and ≥3 as “severely frail.” Results The overall perioperative complication rate was 19.3% and in-patient mortality was 3.0%. Compared with patients with no frailty, patients with moderate frailty (odds ratio [OR] 5.15; 95% confidence interval [95% CI] 2.44–10.86), and severe frailty (OR 5.74; 95% CI 2.69–12.24) had significantly increased odds of inpatient mortality (all P < 0.001). Similarly, patients with mild frailty (OR 1.88; 95% CI 1.33–2.66), moderate frailty (OR 3.83; 95% CI 2.71–5.41), and severe frailty (OR 6.97; 95% CI 4.98–9.74) had significantly increased odds of developing a major in-hospital complication (all P < 0.001). Length of stay also increased significantly by MSTFI (P < 0.001). Conclusions In surgically treated patients with spinal metastasis, certain perioperative parameters may significantly predict the risk of major in-hospital complications and mortality.
AB - Objective The aim of this study was to develop a perioperative metastatic spinal tumor frailty index (MSTFI) that could predict morbidity, mortality, and length of stay. Methods A large inpatient hospitalization database was searched from 2002 to 2011 to identify 4583 patients with spinal metastasis from breast (21.1%), lung (34.1%), thyroid (3.8%), renal (19.9%), and prostate (21.1%) cancer who underwent surgery. A multiple logistic regression model identified 9 independent parameters that were used to construct the MSTFI: anemia, chronic lung disease, coagulopathy, electrolyte abnormalities, pulmonary circulation disorders, renal failure, malnutrition, emergent/urgent admission, and anterior/combined surgical approach. Patients with 0 points were categorized as “not frail,” 1 as “mildly frail,” 2 as “moderately frail,” and ≥3 as “severely frail.” Results The overall perioperative complication rate was 19.3% and in-patient mortality was 3.0%. Compared with patients with no frailty, patients with moderate frailty (odds ratio [OR] 5.15; 95% confidence interval [95% CI] 2.44–10.86), and severe frailty (OR 5.74; 95% CI 2.69–12.24) had significantly increased odds of inpatient mortality (all P < 0.001). Similarly, patients with mild frailty (OR 1.88; 95% CI 1.33–2.66), moderate frailty (OR 3.83; 95% CI 2.71–5.41), and severe frailty (OR 6.97; 95% CI 4.98–9.74) had significantly increased odds of developing a major in-hospital complication (all P < 0.001). Length of stay also increased significantly by MSTFI (P < 0.001). Conclusions In surgically treated patients with spinal metastasis, certain perioperative parameters may significantly predict the risk of major in-hospital complications and mortality.
KW - Cancer
KW - Frailty
KW - Frailty index
KW - Metastasis
KW - Spinal metastatic tumor
KW - Spine surgery
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U2 - 10.1016/j.wneu.2016.08.029
DO - 10.1016/j.wneu.2016.08.029
M3 - Article
C2 - 27544340
AN - SCOPUS:84992679360
SN - 1878-8750
VL - 95
SP - 548-555.e4
JO - World neurosurgery
JF - World neurosurgery
ER -