Chitale Rohan, Campbell Peter G, Yadla Sanjay, Whitmore Robert G, Maltenfort Mitchell G, Ratliff John K
*Department of Neurological Surgery, Thomas Jefferson University †Department of Neurosurgery, University of Pennsylvania ‡Rothman Institute, Thomas Jefferson University, Philadelphia, PA §Department of Neurosurgery, Stanford University, Stanford, CA.
J Spinal Disord Tech. 2015 May;28(4):126-33. doi: 10.1097/BSD.0b013e318270dad7.
A patient comorbidity score (RCS) was developed from a prospective study of complications occurring in spine surgery patients.
To validate the RCS, we present an International Classification of Disease Clinical Modification (ICD-CM)-9 model of the score and correlate the score with complication incidence in a group of patients from the Nationwide Inpatient Sample database. We compare the predictive value of the score with the Charlson index.
We conducted a retrospective assessment of Nationwide Inpatient Sample patients undergoing cervical or thoracolumbar spine surgery for degenerative pathology from 2002 to 2009.
We generated an ICD-9-CM coding-based model of our prospectively derived RCS, categorizing diagnostic codes to represent relevant comorbidities. Multivariate models were constructed to eliminate the least significant variables. ICD-9-CM coding was also used to calculate a Charlson comorbidity score for each patient. The accuracy of the RCS was compared with the Charlson index through the use of a receiver-operating curve.
A total of 352,535 patients undergoing 369,454 spine procedures for degenerative disease were gathered. Hypertension and hyperlipidemia were the most common comorbidities. Cervical procedures resulted in 8286 complications (4.50%), whereas thoracolumbar procedures produced 25,118 complications (13.55%). Increasing RCS correlated linearly with increasing complication incidence (odds ratio [OR] 1.11; 95% confidence interval [CI], 1.10-1.13; P<0.0001). Logistic regression revealed that neurological deficit, cardiac conditions, and drug or alcohol use had greatest association with complication occurrence. The Charlson index also correlated with complication occurrence in both cervical (OR 1.25; 95% CI, 1.23-1.27) and thoracolumbar (OR 1.11; 95% CI, 1.10-1.12) patient groups. Receiver-operating curve analysis allowed a comparison of accuracy of the indices by comparing predictive values. The RCS performed as well as the Charlson index in predicting complication occurrence in both cervical and thoracic spine patients.
ICD-9-based modeling validated that RCS correlates with complication occurrence. The RCS performed as well as the Charlson index in predicting risk of complication in spine patients.
患者合并症评分（RCS）源自一项对脊柱手术患者并发症的前瞻性研究。
为验证RCS，我们提出了该评分的国际疾病分类临床修订版（ICD-CM）-9模型，并将该评分与来自全国住院患者样本数据库的一组患者的并发症发生率相关联。我们将该评分的预测价值与查尔森指数进行比较。
我们对2002年至2009年因退行性病变接受颈椎或胸腰椎脊柱手术的全国住院患者样本进行了回顾性评估。
我们基于前瞻性得出的RCS生成了一个基于ICD-9-CM编码的模型，将诊断编码分类以代表相关合并症。构建多变量模型以消除最不重要的变量。还使用ICD-9-CM编码为每位患者计算查尔森合并症评分。通过使用受试者工作特征曲线将RCS的准确性与查尔森指数进行比较。
共收集了352,535例因退行性疾病接受369,454例脊柱手术的患者。高血压和高脂血症是最常见的合并症。颈椎手术导致8286例并发症（4.50%），而胸腰椎手术产生25,118例并发症（13.55%）。RCS增加与并发症发生率增加呈线性相关（优势比[OR]1.11；95%置信区间[CI]，1.10 - 1.13；P<0.0001）。逻辑回归显示神经功能缺损、心脏疾病以及药物或酒精使用与并发症发生的关联最大。查尔森指数在颈椎（OR 1.25；95% CI，1.23 - 1.27）和胸腰椎（OR 1.11；95% CI，1.10 - 1.12）患者组中也与并发症发生相关。受试者工作特征曲线分析通过比较预测值来比较各指数的准确性。在预测颈椎和胸椎患者并发症发生方面，RCS的表现与查尔森指数相当。
基于ICD-9的模型验证了RCS与并发症发生相关。在预测脊柱患者并发症风险方面，RCS的表现与查尔森指数相当。
