1Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
2Cleveland Clinic Lerner College of Medicine, Cleveland.
J Neurosurg Spine. 2021 Jan 29;34(4):580-588. doi: 10.3171/2020.8.SPINE20577. Print 2021 Apr 1.
Patient demographics, comorbidities, and baseline quality of life (QOL) are major contributors to postoperative outcomes. The frequency and cost of lumbar spine surgery has been increasing, with controversy revolving around optimal management strategies and outcome predictors. The goal of this study was to generate predictive nomograms and a clinical calculator for postoperative clinical and QOL outcomes following lumbar spine surgery for degenerative disease.
Patients undergoing lumbar spine surgery for degenerative disease at a single tertiary care institution between June 2009 and December 2012 were retrospectively reviewed. Nomograms and an online calculator were modeled based on patient demographics, comorbidities, presenting symptoms and duration of symptoms, indication for surgery, type and levels of surgery, and baseline preoperative QOL scores. Outcomes included postoperative emergency department (ED) visit or readmission within 30 days, reoperation within 90 days, and 1-year changes in the EuroQOL-5D (EQ-5D) score. Bootstrapping was used for internal validation.
A total of 2996 lumbar surgeries were identified. Thirty-day ED visits were seen in 7%, 30-day readmission in 12%, 90-day reoperation in 3%, and improvement in EQ-5D at 1 year that exceeded the minimum clinically important difference in 56%. Concordance indices for the models predicting ED visits, readmission, reoperation, and dichotomous 1-year improvement in EQ-5D were 0.63, 0.66, 0.73, and 0.84, respectively. Important predictors of clinical outcomes included age, body mass index, Charlson Comorbidity Index, indication for surgery, preoperative duration of symptoms, and the type (and number of levels) of surgery. A web-based calculator was created, which can be accessed here: https://riskcalc.org/PatientsEligibleForLumbarSpineSurgery/.
The prediction tools derived from this study constitute important adjuncts to clinical decision-making that can offer patients undergoing lumbar spine surgery realistic and personalized expectations of postoperative outcome. They may also aid physicians in surgical planning, referrals, and counseling to ultimately lead to improved patient experience and outcomes.
患者的人口统计学特征、合并症和基线生活质量（QOL）是术后结果的主要影响因素。腰椎手术的频率和费用一直在增加，其最佳管理策略和结果预测因素存在争议。本研究的目的是为退行性疾病的腰椎手术后的临床和 QOL 结果生成预测诺模图和临床计算器。
回顾性分析 2009 年 6 月至 2012 年 12 月在一家三级保健机构接受退行性腰椎手术的患者。根据患者的人口统计学特征、合并症、主要症状和症状持续时间、手术指征、手术类型和水平以及基线术前 QOL 评分，建立诺模图和在线计算器。结果包括术后 30 天内急诊（ED）就诊或再入院、90 天内再次手术以及 1 年时欧洲五维健康量表（EQ-5D）评分的变化。Bootstrapping 用于内部验证。
共确定了 2996 例腰椎手术。30 天内 ED 就诊率为 7%，30 天内再入院率为 12%，90 天内再次手术率为 3%，1 年时 EQ-5D 改善超过最小临床重要差异的比例为 56%。预测 ED 就诊、再入院、再次手术和 1 年 EQ-5D 二分法改善的模型的一致性指数分别为 0.63、0.66、0.73 和 0.84。临床结果的重要预测因素包括年龄、体重指数、Charlson 合并症指数、手术指征、术前症状持续时间以及手术类型（和手术节段数）。创建了一个基于网络的计算器，可在此处访问：https://riskcalc.org/PatientsEligibleForLumbarSpineSurgery/。
本研究得出的预测工具是临床决策的重要辅助手段，可为接受腰椎手术的患者提供术后结果的现实和个性化预期。它们还可以帮助医生进行手术规划、转诊和咨询，最终改善患者的体验和结果。
