Kazim Syed Faraz, Dicpinigaitis Alis J, Bowers Christian A, Shah Smit, Couldwell William T, Thommen Rachel, Alvarez-Crespo Daniel J, Conlon Matthew, Tarawneh Omar H, Vellek John, Cole Kyrill L, Dominguez Jose F, Mckee Rohini N, Ricks Christian B, Shin Peter C, Cole Chad D, Schmidt Meic H
Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA.
School of Medicine, New York Medical College, Valhalla, NY, USA.
Neurospine. 2022 Mar;19(1):53-62. doi: 10.14245/ns.2142770.385. Epub 2022 Feb 2.
The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry.
The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients' data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5.
Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. 'Severely frail' patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21-35.44) for 30-day mortality, 3.02 (95% CI, 1.97-4.56) for major complications, and 2.94 (95% CI, 2.32-4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality.
Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.
本研究旨在利用一个大型国家登记处的数据，评估基线衰弱状态（通过改良衰弱指数-5 [mFI-5] 衡量）与年龄对接受脊柱肿瘤手术患者术后结局的影响。
使用国家外科质量改进计划数据库收集2015年至2019年脊柱肿瘤切除术患者的数据（n = 4662）。对年龄和mFI-5进行单因素和多因素分析，以评估以下结局：30天死亡率、主要并发症、计划外再次手术、计划外再入院、住院时间（LOS）以及出院至非家庭目的地。采用受试者工作特征（ROC）曲线分析来评估年龄与mFI-5的判别性能。
单因素和多因素分析均表明，与年龄相比，mFI-5是术后不良结局更有力的预测指标。此外，基于衰弱等级的分类分析，衰弱程度增加与不良结局风险增加显著相关。发现“严重衰弱”患者风险最高，30天死亡率的优势比为16.4（95%置信区间 [CI]，11.21 - 35.44），主要并发症的优势比为3.02（95% CI，1.97 - 4.56），住院时间的优势比为2.94（95% CI，2.32 - 4.21）。在ROC曲线分析中，mFI-5评分（曲线下面积 [AUC] = 0.743）在预测死亡率方面比年龄（AUC = 0.594）具有更好的判别性能。
与年龄相比，通过mFI-5衡量的衰弱程度增加是脊柱肿瘤手术患者术后不良结局更有力的预测指标。mFI-5可在临床上用于脊柱肿瘤患者的术前风险分层。
