Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2020 Jul;139:526-534. doi: 10.1016/j.wneu.2020.04.169. Epub 2020 Apr 29.
Patient counseling and selection for surgical therapy in adult Chiari malformation type I (CM-1) remain debatable. We aimed to develop a clinical calculator predicting the risk of nonhome discharge and reoperation using the American College of Surgeons-National Surgical Quality Improvement Program database.
The database from years 2011 through 2017 was queried to identify the subset of CM-1 patients undergoing suboccipital decompression. Univariable analysis was conducted to identify baseline factors associated with nonhome discharge and 30-day reoperation following the initial decompression procedure. Logistic regression and the Akaike Information Criterion were used to identify the optimal models predictive of both outcomes. Performance was assessed using receiver operating curves and validated with bootstrapping.
In 706 CM-1 patients, the rate of nonhome discharge was 5.2% and the reoperation rate was 6.6% with most reoperations consisting of cerebrospinal fluid flow diversion and cerebrospinal fluid leak repair. The optimal model predictive of nonhome discharge consisted of age (odds ratio [OR] = 1.05, P = 0.001), diabetes (OR = 2.44, P = 0.080), and American Society of Anesthesiologists class (OR = 1.94, P = 0.082) with an area under the curve of 0.720. The optimal model predictive of reoperation consisted of female sex (OR = 0.48, P = 0.031), body mass index (OR = 1.05, P = 0.002), and ASA class (OR = 3.44, P = 0.001) with an area under the curve of 0.726. A calculator for both outcomes was deployed under the following URL: https://jhuspine3.shinyapps.io/Discharge_Reop_Calculator/.
We have used a large international database to develop a simple risk calculator based on readily available preoperative variables. Following subsequent validation, this tool can help optimize patient counseling and decision making in adult CM-1.
成人 Chiari 畸形 I 型（CM-1）的患者咨询和手术治疗选择仍存在争议。我们旨在使用美国外科医师学院-国家手术质量改进计划数据库开发一种预测非出院风险和再手术的临床计算器。
查询 2011 年至 2017 年期间的数据库，以确定接受枕下减压术的 CM-1 患者亚组。进行单变量分析以确定与初始减压术后非出院和 30 天再手术相关的基线因素。使用逻辑回归和赤池信息量准则确定预测这两种结果的最佳模型。使用接收者操作曲线评估性能，并通过自举进行验证。
在 706 例 CM-1 患者中，非出院率为 5.2%，再手术率为 6.6%，大多数再手术包括脑脊液分流和脑脊液漏修复。预测非出院的最佳模型包括年龄（优势比 [OR] = 1.05，P = 0.001）、糖尿病（OR = 2.44，P = 0.080）和美国麻醉医师协会分级（OR = 1.94，P = 0.082），曲线下面积为 0.720。预测再手术的最佳模型包括女性（OR = 0.48，P = 0.031）、体重指数（OR = 1.05，P = 0.002）和 ASA 分级（OR = 3.44，P = 0.001），曲线下面积为 0.726。这两种结果的计算器已部署在以下 URL 下：https://jhuspine3.shinyapps.io/Discharge_Reop_Calculator/。
我们使用大型国际数据库开发了一种基于术前易于获得的变量的简单风险计算器。在随后的验证后，该工具可以帮助优化成人 CM-1 的患者咨询和决策。
