Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2018 Jun 1;43(11):798-804. doi: 10.1097/BRS.0000000000002418.
Retrospective cohort study of prospectively collected data.
The aim of this study was to investigate the influence of changes in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database over the years on the calculation of the modified Frailty Index (mFI) and the modified Charlson Comorbidity Index (mCCI) for posterior lumbar fusion studies.
Multiple studies have utilized the mFI and/or mCCI and showed them to be predictors of adverse postoperative outcomes. However, changes in the NSQIP database have resulted in definition changes and/or missing data for many of the variables included in these indices. No studies have assessed the influence of different methods of treating missing values when calculating these indices on such studies.
Elective posterior lumbar fusions were identified in NSQIP from 2005 to 2014. The mFI was calculated for each patient using three methods: treating conditions for which data was missing as not present, dropping patients with missing values, and normalizing by dividing the raw score by the number of variables collected. The mCCI was calculated by the first two of these methods. Mean American Society of Anesthesiologists (ASA) scores used for comparison.
In total, 19,755 patients were identified. Mean ASA score increased between 2005 and 2014 from 2.27 to 2.50 (+10.1%). For each of the methods of data handling noted above, mean mFI over the years studied increased by 33.3%, could not be calculated, and increased by 183.3%, respectively. Mean mCCI increased by 31.2% and could not be calculated respectively.
Systematic changes in the NSQIP database have resulted in missing data for many of the variables included in the mFI and the mCCI and may affect studies utilizing these indices. These changes can be understood in the context of ASA trends, and raise questions regarding the use of these indices with data available in later NSQIP years.
前瞻性收集数据的回顾性队列研究。
本研究旨在探讨美国外科医师学会国家手术质量改进计划（NSQIP）数据库多年来的变化对后路腰椎融合研究中改良衰弱指数（mFI）和改良 Charlson 合并症指数（mCCI）计算的影响。
多项研究已经使用 mFI 和/或 mCCI，并表明它们是术后不良结果的预测因素。然而，NSQIP 数据库的变化导致这些指数中包含的许多变量的定义发生变化和/或数据缺失。没有研究评估在计算这些指数时，用不同的方法处理缺失值对这些研究的影响。
从 2005 年到 2014 年，在 NSQIP 中确定了选择性后路腰椎融合术。使用三种方法计算每位患者的 mFI：将数据缺失的情况视为不存在，删除有缺失值的患者，以及通过将原始分数除以收集的变量数进行归一化。使用前两种方法计算 mCCI。使用平均美国麻醉医师协会（ASA）评分进行比较。
共确定了 19755 名患者。2005 年至 2014 年间，平均 ASA 评分从 2.27 增加到 2.50（增加 10.1%）。对于上述数据处理方法中的每一种，研究期间的平均 mFI 分别增加了 33.3%、无法计算和增加了 183.3%。平均 mCCI 分别增加了 31.2%和无法计算。
NSQIP 数据库中的系统性变化导致 mFI 和 mCCI 中包含的许多变量出现数据缺失，这可能会影响使用这些指数的研究。这些变化可以根据 ASA 趋势来理解，并提出了关于在后期 NSQIP 年份使用这些指数的问题。
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