Kassicieh Alexander J, Rumalla Kavelin, Segura Aaron C, Kazim Syed Faraz, Vellek John, Schmidt Meic H, Shin Peter C, Bowers Christian A
Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA.
Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA.
Neurospine. 2023 Mar;20(1):119-128. doi: 10.14245/ns.2346110.055. Epub 2023 Mar 31.
The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for singlelevel lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition.
Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017-2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver.
Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65-0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73-0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85-0.88).
After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decisionmaking with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo.
内镜脊柱手术（ESS）方法具有患者满意度高、恢复时间短和并发症减少的特点。本研究报告了多中心国际数据，比较了ESS和非ESS方法用于单节段腰椎减压的情况，并提出了一种基于虚弱程度的非回家出院（NHD）处置预测模型。
从美国外科医师学会国家外科质量改进计划数据库（2017 - 2020年）中查询ESS和非ESS腰椎减压病例。对基线特征虚弱评分（通过风险分析指数[RAI]和改良虚弱指数 - 5[mFI - 5]测量）进行倾向评分匹配。感兴趣的主要结局是NHD处置。使用以RAI为主要驱动因素的逻辑回归建立预测模型。
38686例患者接受了单节段非融合性脊柱腰椎减压手术。通过RAI测量的虚弱程度是NHD的可靠预测指标，在受试者工作特征（ROC）曲线分析中具有出色的区分准确性：ESS队列的C统计量为0.80（95%置信区间[CI]，0.65 - 0.94），总体队列的C统计量为0.75（95%CI，0.73 - 0.76）。倾向评分匹配后，接受内镜治疗的患者总手术时间减少（89分钟对103分钟，p = 0.049），住院时间（LOS）缩短（0.82天对1.37天，p < 0.001）。在ROC曲线分析中，基于虚弱程度的预测模型对NHD主要结局的诊断准确性极佳（C统计量：0.87；95%CI，0.85 - 0.88）。
基于虚弱程度的倾向匹配后，ESS与手术时间减少、住院LOS缩短和NHD减少相关。RAI基于虚弱程度的模型对NHD具有出色的诊断准确性，可通过用户友好的计算器应用于术前决策：nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo 。
