Caplan Ian F, Zadnik Sullivan Patricia, Glauser Gregory, Choudhri Omar, Kung David, O'Rourke Donald M, Osiemo Benjamin, Goodrich Stephen, McClintock Scott D, Malhotra Neil R
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA.
McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, 19104, USA; West Chester University, The West Chester Statistical Institute and Department of Mathematics, 25 University Ave, West Chester, PA, 19383, USA.
Clin Neurol Neurosurg. 2019 Jul;182:79-83. doi: 10.1016/j.clineuro.2019.04.026. Epub 2019 May 1.
The LACE + index (Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months) is a tool utilized to predict 30-90 day readmission and other secondary outcomes. We sought to examine the effectiveness of this predictive tool in patients undergoing brain tumor surgery.
Admissions and readmissions for patients undergoing craniotomy for supratentorial neoplasm at a single, multi-hospital, academic medical center, were analyzed. Key data was prospectively collected with the Neurosurgery Quality Improvement Initiative (NQII)-EpiLog tool. This included all supratentorial craniotomy cases for which the patient was alive at 90 days after surgery (n = 238). Simple logistic regression analyses were used to assess the ability of the LACE + index and subsequent single variables to accurately predict the outcome measures of 30-90 day readmission, 30-90 day emergency department (ED) visit, and 30-90 day reoperation. Analysis of the model's or variable's discrimination was determined by the receiver operating characteristic curve as represented by the C-statistic.
The sample included admissions for craniotomy for supratentorial neoplasm (n = 238) from 227 patients, of which 50.00% were female (n = 119). The average LACE + index score was 53.48 ± 16.69 (Range 9-83). The LACE + index did not accurately predict 30-90 day readmissions (P = 0.127), 30-90 day ED visits (P = 0.308), nor reoperations (P = 0.644). ROC confirmed that the LACE + index was little better than random chance at predicting these events in this population (C-statistic = 0.51-0.58). However, a single unit increase in LACE + leads to a 0.97 times reduction in the odds of being discharged home with fair predictive accuracy (P < 0.001, CI = 0.96-0.98, C-statistic = 0.69).
The results of this study show that the LACE + index is ill-equipped to predict 30-90 day readmissions in the brain tumor population and further analysis of significant covariates or other prediction tools should be undertaken.
LACE+指数(住院时间、入院急症程度、查尔森合并症指数(CCI)评分以及过去6个月内的急诊科就诊次数)是一种用于预测30至90天再入院率及其他次要结果的工具。我们试图检验该预测工具在接受脑肿瘤手术患者中的有效性。
对一家多医院学术医疗中心接受幕上肿瘤开颅手术患者的入院和再入院情况进行分析。关键数据通过神经外科质量改进计划(NQII)-EpiLog工具前瞻性收集。这包括所有幕上开颅手术病例,患者术后90天仍存活(n = 238)。采用简单逻辑回归分析评估LACE+指数及后续单一变量准确预测30至90天再入院率、30至90天急诊科就诊率和30至90天再次手术等结果指标的能力。通过C统计量表示的受试者工作特征曲线确定模型或变量的鉴别分析。
样本包括227例幕上肿瘤开颅手术的入院病例(n = 238),其中50.00%为女性(n = 119)。LACE+指数平均得分为53.48±16.69(范围9 - 83)。LACE+指数不能准确预测30至90天再入院率(P = 0.127)、30至90天急诊科就诊率(P = 0.308)或再次手术率(P = 0.644)。ROC曲线证实,在该人群中,LACE+指数在预测这些事件方面仅略优于随机概率(C统计量 = 0.51 - 0.58)。然而,LACE+每增加一个单位,出院回家几率降低0.97倍,预测准确性尚可(P < 0.001,CI = 0.96 - 0.98,C统计量 = 0.69)。
本研究结果表明,LACE+指数在预测脑肿瘤患者30至90天再入院率方面能力不足,应进一步分析显著的协变量或其他预测工具。