Rumalla Kavelin, Thommen Rachel, Kazim Syed Faraz, Segura Aaron C, Kassicieh Alexander J, Schmidt Meic H, Bowers Christian A
Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States.
J Neurol Surg B Skull Base. 2023 Feb 13;85(2):168-171. doi: 10.1055/a-2015-1162. eCollection 2024 Apr.
The aim of this study was to evaluate the discriminative accuracy of the preoperative Risk Analysis Index (RAI) frailty score for prediction of mortality or transition to hospice within 30 days of brain tumor resection (BTR) in a large multicenter, international, prospective database. Records of BTR patients were extracted from the American College of Surgeons National Surgical Quality Improvement Program (2012-2020) database. The relationship between the RAI frailty scale and the primary end point (mortality or discharge to hospice within 30 days of surgery) was assessed using linear-by-linear proportional trend tests, logistic regression, and receiver operating characteristic (ROC) curve analysis (area under the curve as C-statistic). Patients with BTR ( = 31,776) were stratified by RAI frailty tier: 16,800 robust (52.8%), 7,646 normal (24.1%), 6,593 frail (20.7%), and 737 severely frail (2.3%). The mortality/hospice rate was 2.5% ( = 803) and was positively associated with increasing RAI tier: robust (0.9%), normal (3.3%), frail (4.6%), and severely frail (14.2%) ( < 0.001). Isolated RAI was a robust discriminatory of primary end point in ROC curve analysis in the overall BTR cohort (C-statistic: 0.74; 95% confidence interval [CI]: 0.72-0.76) as well as the malignant (C-statistic: 0.74; 95% CI: 0. 67-0.80) and benign (C-statistic: 0.71; 95% CI: 0.70-0.73) tumor subsets (all < 0.001). RAI score had statistically significantly better performance compared with the 5-factor modified frailty index and chronological age (both < 0.0001). RAI frailty score predicts 30-day mortality after BTR and may be translated to the bedside with a user-friendly calculator ( https://nsgyfrailtyoutcomeslab.shinyapps.io/braintumormortalityRAIcalc/ ). The findings hope to augment the informed consent and surgical decision-making process in this patient population and provide an example for future study designs.
本研究旨在评估术前风险分析指数（RAI）虚弱评分在一个大型多中心、国际性、前瞻性数据库中预测脑肿瘤切除（BTR）术后30天内死亡率或转至临终关怀机构的判别准确性。
从美国外科医师学会国家外科质量改进计划（2012 - 2020年）数据库中提取BTR患者的记录。使用线性 - 线性比例趋势检验、逻辑回归和受试者工作特征（ROC）曲线分析（曲线下面积作为C统计量）评估RAI虚弱量表与主要终点（术后30天内死亡或出院至临终关怀机构）之间的关系。
BTR患者（n = 31,776）按RAI虚弱等级分层：16,800例强壮（52.8%）、7,646例正常（24.1%）、6,593例虚弱（20.7%）和737例严重虚弱（2.3%）。死亡率/临终关怀率为2.5%（n = 803），且与RAI等级增加呈正相关：强壮（0.9%）、正常（3.3%）、虚弱（4.6%）和严重虚弱（14.2%）（P < 0.001）。在整个BTR队列的ROC曲线分析中，单独的RAI是主要终点的有力判别指标（C统计量：0.74；95%置信区间[CI]：0.72 - 0.76），在恶性肿瘤（C统计量：0.74；95% CI：0.67 - 0.80）和良性肿瘤亚组（C统计量：0.71；95% CI：0.70 - 0.73）中也是如此（均P < 0.001）。与5因素改良虚弱指数和实际年龄相比，RAI评分在统计学上具有显著更好的性能（均P < 0.0001）。
RAI虚弱评分可预测BTR术后30天死亡率，并且可以通过一个用户友好的计算器（https://nsgyfrailtyoutcomeslab.shinyapps.io/braintumormortalityRAIcalc/）应用于临床。这些发现有望加强该患者群体的知情同意和手术决策过程，并为未来的研究设计提供一个范例。
