Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.
Spine (Phila Pa 1976). 2019 Jul 1;44(13):E782-E787. doi: 10.1097/BRS.0000000000002970.
STUDY DESIGN: A retrospective review of prospectively collected data. OBJECTIVE: The purpose of this study is to compare and validate several preoperative scores for predicting outcomes following spine tumor resection. SUMMARY OF BACKGROUND DATA: Preoperative risk assessment for patients undergoing spinal tumor resection remains challenging. At present, few risk assessment tools have been validated in this high-risk population. METHODS: The 2008 to 2014 National Surgical Quality Improvement database was used to identify all patients undergoing surgical resection of spinal tumors, stratified as extradural, intradural extramedullary, and intramedullary based on CPT codes. American Society of Anesthesiologists (ASA) score, modified Charlson Comorbidity Index (CCI), and modified Frailty Index (mFI) were computed. A binary logistic regression model was used to explore the relationship between these variables and postoperative outcomes, including mortality, major and minor adverse events, and hospital length of stay (LOS). Other significant variables such as demographics, operative time, and tumor location were controlled for in each model. RESULTS: Two thousand one hundred seventy patients met the inclusion criteria. Higher CCI scores were independent predictors of mortality (OR = 1.24, 95% CI: 1.14-1.36, P < 0.001), major adverse events (OR = 1.07, 95% CI: 1.01-1.31, P = 0.018), minor adverse events (OR = 1.15, 95% CI: 1.10-1.20, P < 0.001), and prolonged LOS (OR = 1.14, 95% CI: 1.09-1.19, P < 0.001). Patients' mFI scores were significantly associated with mortality and LOS, but not major or minor adverse events. ASA scores were not associated with any outcome metric when controlling for other variables. CONCLUSION: The CCI demonstrated superior predictive capacity compared with mFI and ASA scores and may be valuable as a preoperative risk assessment tool for patients undergoing surgical resection of spinal tumors. The validation of assessment scores is important for preoperative risk stratification and improving outcomes in this high-risk group. LEVEL OF EVIDENCE: 3.
研究设计：前瞻性数据回顾性研究。 目的：本研究旨在比较和验证几种用于预测脊柱肿瘤切除术后结果的术前评分。 背景资料概要：脊柱肿瘤切除术后患者的术前风险评估仍然具有挑战性。目前，很少有风险评估工具在这一高危人群中得到验证。 方法：使用 2008 年至 2014 年国家手术质量改进数据库，根据 CPT 代码，确定所有接受脊柱肿瘤切除术的患者，分为硬膜外、硬膜内外和髓内。计算美国麻醉医师协会（ASA）评分、改良 Charlson 合并症指数（CCI）和改良虚弱指数（mFI）。采用二元逻辑回归模型探讨这些变量与术后结局（包括死亡率、主要和次要不良事件以及住院时间（LOS））之间的关系。在每个模型中，还控制了其他重要变量，如人口统计学、手术时间和肿瘤位置。 结果：2170 名符合纳入标准的患者。CCI 评分越高是死亡率（OR=1.24，95%CI：1.14-1.36，P<0.001）、主要不良事件（OR=1.07，95%CI：1.01-1.31，P=0.018）、次要不良事件（OR=1.15，95%CI：1.10-1.20，P<0.001）和延长 LOS（OR=1.14，95%CI：1.09-1.19，P<0.001）的独立预测因素。患者的 mFI 评分与死亡率和 LOS 显著相关，但与主要或次要不良事件无关。ASA 评分在控制其他变量后与任何结局指标均无关。 结论：CCI 与 mFI 和 ASA 评分相比，具有更好的预测能力，可作为脊柱肿瘤切除患者术前风险评估的有用工具。评估评分的验证对于高危人群的术前风险分层和改善结局非常重要。 证据水平：3 级。
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