Elsamadicy Aladine A, Serrato Paul, Sadeghzadeh Sina, Sayeed Sumaiya, Hengartner Astrid C, Khalid Syed I, Lo Sheng-Fu Larry, Shin John H, Mendel Ehud, Sciubba Daniel M
Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
J Neurooncol. 2025 Jan;171(1):213-228. doi: 10.1007/s11060-024-04830-z. Epub 2024 Sep 25.
Risk Analysis Index (RAI) has been increasingly used to assess surgical frailty in various procedures, but its effectiveness in predicting mortality or in-patient hospital outcomes for spine surgery in metastatic disease remains unclear. The aim of this study was to compare the predictive values of the revised RAI (RAI-rev), the modified frailty index-5 (mFI-5), and advanced age for extended length of stay, 30-day readmission, complications, and mortality among patients undergoing spine surgery for metastatic spinal tumors.
A retrospective cohort study was performed using the 2012-2022 ACS NSQIP database to identify adult patients who underwent spinal surgery for metastatic spinal pathologies. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI-rev, mFI-5, and greater patient age with extended length of stay (LOS), 30-day complications, hospital readmission, and mortality.
A total of 1,796 patients were identified, of which 1,116 (62.1%) were male and 1,008 (70.7%) were non-Hispanic White. RAI-rev identified 1,291 (71.9%) frail and 208 (11.6%) very frail patients, while mFI-5 identified 272 (15.1%) frail and 49 (2.7%) very frail patients. In the ROC analysis for extended LOS, both RAI-rev and mFI-5 showed modest predictive capabilities with area under the curve (AUC) values of 0.5477 and 0.5329, respectively, and no significant difference in their predictive abilities (p = 0.446). When compared to age, RAI-rev demonstrated superior prediction (p = 0.015). With respect to predicting 30-day readmission, no significant difference was observed between RAI-rev and mFI-5 (AUC 0.5394 l respectively, p = 0.354). However, RAI-rev outperformed age (p = 0.001). When assessing the risk of 30-day complications, RAI-rev significantly outperformed mFI-5 (AUC: 0.6016 and 0.5542 respectively, p = 0.022) but not age. Notably, RAI-rev demonstrated superior ability for predicting 30-day mortality compared to mFI-5 and age (AUC: 0.6541, 0.5652, and 0.5515 respectively, p < 0.001). Multivariate analysis revealed RAI-rev as a significant predictor of extended LOS [aOR: 1.96, 95% CI: 1.13-3.38, p = 0.016] and 30-day mortality [aOR: 5.27, 95% CI: 1.73-16.06, p = 0.003] for very frail patients. Similarly, the RAI-rev significantly predicted 30-day complications for frail [aOR: 2.63, 95% CI: 1.21-5.72, p = 0.015] and very frail [aOR: 3.69, 95% CI: 1.60-8.51, p = 0.002] patients. However, the RAI did not significantly predict 30-day readmission [Very Frail aOR: 1.52, 95% CI: 0.75-3.07, p = 0.245; Frail aOR: 1.46, 95% CI: 0.79-2.68, p = 0.225].
Our study demonstrates the utility of RAI-rev in predicting morbidity and mortality in patients undergoing spine surgery for metastatic spinal pathologies. Particularly, the superiority that RAI-rev has in predicting 30-day mortality may have significant implications in multidisciplinary decision making.
风险分析指数（RAI）已越来越多地用于评估各种手术中的手术脆弱性，但其在预测转移性疾病脊柱手术的死亡率或住院结局方面的有效性仍不明确。本研究的目的是比较修订后的RAI（RAI-rev）、改良脆弱指数-5（mFI-5）和高龄对转移性脊柱肿瘤脊柱手术患者延长住院时间、30天再入院、并发症和死亡率的预测价值。
使用2012 - 2022年美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库进行一项回顾性队列研究，以确定接受转移性脊柱疾病脊柱手术的成年患者。使用受试者工作特征（ROC）和多变量分析，我们比较了RAI-rev、mFI-5和较高患者年龄与延长住院时间（LOS）、30天并发症、医院再入院和死亡率的判别阈值及独立关联。
共识别出1796例患者，其中1116例（62.1%）为男性，1008例（70.7%）为非西班牙裔白人。RAI-rev识别出1291例（71.9%）脆弱患者和208例（11.6%）非常脆弱患者，而mFI-5识别出272例（15.1%）脆弱患者和49例（2.7%）非常脆弱患者。在延长LOS的ROC分析中，RAI-rev和mFI-5均显示出适度的预测能力，曲线下面积（AUC）值分别为0.5477和0.5329，且预测能力无显著差异（p = 0.446）。与年龄相比，RAI-rev显示出更好的预测效果（p = 0.015）。关于预测30天再入院，RAI-rev和mFI-5之间未观察到显著差异（AUC分别为0.5394，p = 0.354）。然而，RAI-rev优于年龄（p = 0.001）。在评估30天并发症风险时，RAI-rev显著优于mFI-5（AUC分别为0.6016和0.5542，p = 0.022），但不优于年龄。值得注意的是，与mFI-5和年龄相比，RAI-rev在预测30天死亡率方面表现出更好的能力（AUC分别为0.6541、0.5652和0.5515，p < 0.001）。多变量分析显示，RAI-rev是非常脆弱患者延长LOS [调整后比值比（aOR）：1.96，95%置信区间（CI）：1.13 - 3.38，p = 0.016]和30天死亡率 [aOR：5.27，95% CI：1.73 - 16.06，p = 0.003]的显著预测因素。同样，RAI-rev显著预测了脆弱 [aOR：2.63，95% CI：1.21 - 5.72，p = 0.015]和非常脆弱 [aOR：3.69，95% CI：1.60 - 8.51，p = 0.002]患者的30天并发症。然而，RAI未显著预测30天再入院 [非常脆弱aOR：1.52，95% CI：0.75 - 3.07，p = 0.245；脆弱aOR：1.46，95% CI：0.79 - 2.68，p = 0.225]。
我们的研究证明了RAI-rev在预测转移性脊柱疾病脊柱手术患者的发病率和死亡率方面的效用。特别是，RAI-rev在预测30天死亡率方面的优势可能对多学科决策具有重要意义。
