Covell Michael M, Rumalla Kavelin, Kassicieh Alexander J, Segura Aaron C, Kazim Syed Faraz, Schmidt Meic H, Bowers Christian A
School of Medicine, Georgetown University, Washington, DC, USA.
Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA.
Spine J. 2023 May;23(5):739-745. doi: 10.1016/j.spinee.2022.12.014. Epub 2022 Dec 24.
Measurement of frailty with the Risk Analysis Index (RAI) has demonstrated improved outcome prediction compared to other frailty indices across the surgical literature. However, the generalizability and clinical utility of preoperative RAI scoring for prediction of postoperative morbidity after adult spinal deformity surgery is presently unknown. Thus, recent studies have called for an RAI analysis of spine deformity outcomes.
The present study sought to evaluate the discriminatory accuracy of preoperative frailty, as measured by RAI, for predicting postoperative morbidity among adult spine deformity surgery patients using data queried from a large prospective surgical registry representing over 700 hospitals from 49 US states and 11 countries.
STUDY DESIGN/SETTING: Secondary analysis of a prospective surgical registry.
American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011-2020).
The primary endpoint was "adverse discharge outcome" (ADO) defined as discharge to a non-home, non-rehabilitation nursing/chronic care facility.
Adult spine deformity surgeries were queried from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011-2020) using diagnosis and procedure codes. The relationship between increasing preoperative RAI frailty score and increasing rate of primary endpoint (ADO) was assessed with Cochran-Armitage linear trend tests. Discriminatory accuracy was tested by computation of concordance statistics (with 95% confidence interval [CI]) in receiver operating characteristic (ROC) curve analysis.
A total of 3104 patients underwent spine deformity surgery and were stratified by RAI score: 0-10: 22%, 11-15: 11%, 16-20: 29%, 21-25: 26%, 26-30: 8.0%, 31-35: 2.4%, and 36+: 1.4%. The rate of ADO was 14% (N=439/3094). The rate of ADO increased significantly with increasing RAI score (p<.0001). RAI demonstrated robust discriminatory accuracy for prediction of ADO in ROC analysis (C-statistic: 0.71, 95% CI: 0.69-0.74, p<.001). In pairwise comparison of ROC curves (DeLong test), RAI demonstrates superior discriminatory accuracy compared to the 5-factor modified frailty index (mFI-5; p<.001).
Preoperative frailty, as measured by RAI, is a robust predictor of postoperative morbidity (measured by ADO) after adult spine deformity surgery. The frailty score may be translated directly to the bedside with a user-friendly risk calculator, deployed here: https://nsgyfrailtyoutcomeslab.shinyapps.io/spineDeformity.
与外科文献中其他衰弱指数相比，使用风险分析指数（RAI）测量衰弱已显示出更好的结局预测能力。然而，术前RAI评分在预测成人脊柱畸形手术后并发症方面的普遍性和临床实用性目前尚不清楚。因此，最近的研究呼吁对脊柱畸形结局进行RAI分析。
本研究旨在使用从代表美国49个州和11个国家700多家医院的大型前瞻性外科登记处查询的数据，评估术前通过RAI测量的衰弱对预测成人脊柱畸形手术患者术后并发症的鉴别准确性。
研究设计/设置：前瞻性外科登记处的二次分析。
美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库（2011-2020年）。
主要终点是“不良出院结局”（ADO），定义为出院至非家庭、非康复护理/长期护理机构。
使用诊断和手术编码从美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库（2011-2020年）中查询成人脊柱畸形手术。使用 Cochr an-Armitage线性趋势检验评估术前RAI衰弱评分增加与主要终点（ADO）发生率增加之间的关系。在受试者工作特征（ROC）曲线分析中，通过计算一致性统计量（95%置信区间[CI]）来测试鉴别准确性。
共有3104例患者接受了脊柱畸形手术，并根据RAI评分进行分层：0-10分：22%，11-15分：11%，16-20分：29%，21-25分：26%，26-30分：8.0%，31-35分：2.4%，36分及以上：1.4%。ADO发生率为14%（N=439/3094）。ADO发生率随RAI评分增加而显著增加（p<0.0001）。在ROC分析中，RAI对ADO的预测显示出强大的鉴别准确性（C统计量：0.71，95%CI：0.69-0.74，p<0.001）。在ROC曲线的成对比较（DeLong检验）中，与五因素改良衰弱指数（mFI-5）相比，RAI显示出更高的鉴别准确性（p<0.001）。
术前通过RAI测量的衰弱是成人脊柱畸形手术后术后并发症（通过ADO测量）的有力预测指标。衰弱评分可以通过一个用户友好的风险计算器直接应用于床边，该计算器可在此处使用：https://nsgyfrailtyoutcomeslab.shinyapps.io/spineDeformity 。
