Link Remy L, Rumalla Kavelin, Courville Evan N, Roy Joanna M, Faraz Kazim Syed, Bowers Christian A, Schmidt Meic H
Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA.
Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87131, USA.
World Neurosurg X. 2023 Apr 24;19:100203. doi: 10.1016/j.wnsx.2023.100203. eCollection 2023 Jul.
Surgeons are frequently faced with challenging clinical dilemmas evaluating whether the benefits of surgery outweigh the substantial risks routinely encountered with spinal tumor surgery. The Clinical Risk Analysis Index (RAI-C) is a robust frailty tool administered via a patient-friendly questionnaire that strives to augment preoperative risk stratification. The objective of the study was to prospectively measure frailty with RAI-C and track postoperative outcomes after spinal tumor surgery.
Patients surgically treated for spinal tumors were followed prospectively from 7/2020-7/2022 at a single tertiary center. RAI-C was ascertained during preoperative visits and verified by the provider. The RAI-C scores were assessed in relation to postoperative functional status (measured by modified Rankin Scale score [mRS]) at the last follow-up visit.
Of 39 patients, 47% were robust (RAI 0-20), 26% normal (21-30), 16% frail (31-40), and 11% severely frail (RAI 41+).). Pathology included primary (59%) and metastatic (41%) tumors with corresponding mRS>2 rates of 17% and 38%, respectively. Tumors were classified as extradural (49%), intradural extramedullary (46%), or intradural intramedullary (5.4%) with mRS>2 rates of 28%, 24%, and 50%, respectively. RAI-C had a positive association with mRS>2 at follow-up: 16% for robust, 20% for normal, 43% for frail, and 67% for severely frail. The two deaths in the series had the highest RAI-C scores (45 and 46) and were patients with metastatic cancer. The RAI-C was a robust and diagnostically accurate predictor of mRS>2 in receiver operating characteristic curve analysis (C-statistic: 0.70, 95 CI: 0.49-0.90).
The findings exemplify the clinical utility of RAI-C frailty scoring for prediction of outcomes after spinal tumor surgery and it has potential to help in the surgical decision-making process as well as surgical consent. As a preliminary case series, the authors intend to provide additional data with a larger sample size and longer follow-up duration in a future study.
外科医生在评估手术益处是否超过脊柱肿瘤手术中常遇到的重大风险时，经常面临具有挑战性的临床困境。临床风险分析指数（RAI-C）是一种通过患者友好型问卷管理的强大衰弱评估工具，旨在加强术前风险分层。本研究的目的是前瞻性地用RAI-C测量衰弱情况，并跟踪脊柱肿瘤手术后的术后结果。
2020年7月至2022年7月在一家单一的三级中心对接受脊柱肿瘤手术治疗的患者进行前瞻性随访。术前访视期间确定RAI-C，并由医务人员核实。在最后一次随访时，根据术后功能状态（用改良Rankin量表评分[mRS]测量）评估RAI-C评分。
39例患者中，47%为强健（RAI 0 - 20），26%为正常（21 - 30），16%为衰弱（31 - 40），11%为严重衰弱（RAI 41+）。病理类型包括原发性肿瘤（59%）和转移性肿瘤（41%），mRS>2的发生率分别为17%和38%。肿瘤分为硬膜外（49%）、硬膜内髓外（46%）或硬膜内髓内（5.4%），mRS>2的发生率分别为28%、24%和50%。随访时，RAI-C与mRS>2呈正相关：强健患者为16%，正常患者为20%，衰弱患者为43%，严重衰弱患者为67%。该系列中的两例死亡患者RAI-C评分最高（45和46），均为转移性癌症患者。在受试者工作特征曲线分析中，RAI-C是mRS>2的强大且诊断准确的预测指标（C统计量：0.70，95%CI：0.49 - 0.90）。
这些发现例证了RAI-C衰弱评分在预测脊柱肿瘤手术后结果方面的临床实用性，它有可能帮助手术决策过程以及手术知情同意。作为一个初步病例系列，作者打算在未来的研究中提供更大样本量和更长随访时间的更多数据。
