Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Case Western Reserve University School of Medicine, Cleveland, Ohio.
World Neurosurg. 2024 Aug;188:e267-e272. doi: 10.1016/j.wneu.2024.05.095. Epub 2024 May 20.
Patients with thoracic metastatic epidural spinal cord compression (MESCC) often undergo extensive surgical decompression to avoid functional decline. Though limited in scope, scales including the revised cardiac risk index (RCRI) are used to stratify surgical risk to predict perioperative morbidity. This study uses the 5-item modified frailty index (mFI-5) to predict outcomes following transpedicular decompression/fusion for high-grade MESCC.
A retrospective chart review was conducted on patients who underwent transpedicular decompression and fusion for MESCC (baseline demographics, spinal instability neoplastic score, preoperative and postoperative Bilsky scores, primary cancer type, and RCRI). Primary outcomes included length of stay (LOS), intraoperative estimated blood loss, readmission/reoperation within 90 days of index surgery, 90-day mortality, and posthospitalization disposition.
One hundred twenty-seven patients were included in our study. Ninety percent of patients' lesions were Bilsky 2 or greater. Increasing frailty, measured by mFI-5, was a significant predictor of increased LOS (P < 0.01) and 90-day mortality (P < 0.05). Multivariate analysis adjusting for sex, body mass index , and age still showed statistical significance (P < 0.05). MFI-5 was not a significant predictor of readmission/reoperation within 90 days or estimated blood loss. Age - not mFI-5 or RCRI - was a significant predictor for posthospitalization nonhome disposition (P = 0.001).
The mFI-5 can serve as a useful predictor of outcomes after transpedicular decompression and fusion for thoracic MESCC as it can account for the patient's frailty. Our study demonstrated the mFI-5 as a predictor of LOS and 90-day mortality. These results provide a background to both understanding and integrating frailty into decision-making in MESCC.
患有胸段转移性硬膜外脊髓压迫症（MESCC）的患者通常需要进行广泛的手术减压以避免功能下降。尽管范围有限，但包括改良心脏风险指数（RCRI）在内的量表被用于分层手术风险，以预测围手术期发病率。本研究使用 5 项改良衰弱指数（mFI-5）来预测高分级 MESCC 患者行经皮椎弓根减压/融合术后的结局。
对接受 MESCC 经皮椎弓根减压和融合术的患者进行回顾性病历分析（基线人口统计学资料、脊柱不稳肿瘤评分、术前和术后 Bilsky 评分、原发癌类型和 RCRI）。主要结局包括住院时间（LOS）、术中估计失血量、索引手术后 90 天内再次入院/再次手术、90 天死亡率和住院后去向。
本研究共纳入 127 例患者。90%的患者病变为 Bilsky 2 级或以上。mFI-5 评估的衰弱程度增加是 LOS 延长（P<0.01）和 90 天死亡率增加（P<0.05）的显著预测因素。调整性别、体重指数和年龄的多变量分析仍显示有统计学意义（P<0.05）。mFI-5 不是 90 天内再次入院/再次手术或估计失血量的显著预测因素。年龄——而不是 mFI-5 或 RCRI——是住院后非家庭去向的显著预测因素（P=0.001）。
mFI-5 可作为胸段 MESCC 经皮椎弓根减压和融合术后结局的有用预测指标，因为它可以反映患者的虚弱程度。本研究表明，mFI-5 可预测 LOS 和 90 天死亡率。这些结果为理解和将衰弱纳入 MESCC 的决策提供了背景。
