Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Bone Joint J. 2024 Dec 1;106-B(12):1469-1476. doi: 10.1302/0301-620X.106B12.BJJ-2024-0100.R1.
Frailty has been gathering attention as a factor to predict surgical outcomes. However, the association of frailty with postoperative complications remains controversial in spinal metastases surgery. We therefore designed a prospective study to elucidate risk factors for postoperative complications with a focus on frailty.
We prospectively analyzed 241 patients with spinal metastasis who underwent palliative surgery from June 2015 to December 2021. Postoperative complications were assessed by the Clavien-Dindo classification; scores of ≥ Grade II were defined as complications. Data were collected regarding demographics (age, sex, BMI, and primary cancer) and preoperative clinical factors (new Katagiri score, Frankel grade, performance status, radiotherapy, chemotherapy, spinal instability neoplastic score, modified Frailty Index-11 (mFI), diabetes, and serum albumin levels). Univariate and multivariate analyses were developed to identify risk factors for postoperative complications (p < 0.05).
Overall, 57 postoperative complications occurred in 47 of 241 (19.5%) patients. The most common complications were wound infection/dehiscence, urinary tract infection, and pneumonia. Univariate analysis identified preoperative radiotherapy (p = 0.028), mFI (p < 0.001), blood loss ≥ 500 ml (p = 0.016), and preoperative molecular targeted drugs (p = 0.030) as potential risk factors. From the receiver operating characteristic curve, the clinically optimal cut-off value of mFI was 0.27 (sensitivity, 46.8%; specificity, 79.9%). Multivariate analysis identified mFI ≥ 0.27 (odds ratio (OR) 2.94 (95% CI 1.44 to 5.98); p = 0.003) and preoperative radiotherapy (OR 2.11 (95% CI 1.00 to 4.46); p = 0.049) as significant risk factors. In particular, urinary tract infection (p = 0.012) and pneumonia (p = 0.037) were associated with mFI ≥ 0.27. Furthermore, the severity of postoperative complications was positively correlated with mFI (p < 0.001).
The mFI is a useful tool to predict the incidence and the severity of postoperative complications in spinal metastases surgery.
衰弱作为预测手术结果的一个因素已引起关注。然而，衰弱与脊柱转移瘤手术术后并发症的关系仍存在争议。因此，我们设计了一项前瞻性研究，旨在阐明与术后并发症相关的危险因素，重点关注衰弱。
我们前瞻性分析了 2015 年 6 月至 2021 年 12 月期间接受姑息性手术治疗的 241 例脊柱转移患者。术后并发症采用 Clavien-Dindo 分类评估；评分≥Ⅱ级定义为并发症。收集患者的人口统计学资料（年龄、性别、BMI 和原发癌）和术前临床资料（新 Katagiri 评分、Frankel 分级、体力状况、放疗、化疗、脊柱不稳肿瘤评分、改良 Frailty Index-11（mFI）、糖尿病和血清白蛋白水平）。采用单因素和多因素分析确定术后并发症的危险因素（p＜0.05）。
241 例患者中，共有 47 例（19.5%）发生 57 例术后并发症。最常见的并发症是伤口感染/裂开、尿路感染和肺炎。单因素分析发现术前放疗（p=0.028）、mFI（p＜0.001）、出血量≥500ml（p=0.016）和术前分子靶向药物（p=0.030）是潜在的危险因素。来自受试者工作特征曲线，mFI 的临床最佳截断值为 0.27（灵敏度 46.8%，特异性 79.9%）。多因素分析发现 mFI≥0.27（优势比（OR）2.94（95%CI 1.44-5.98）；p=0.003）和术前放疗（OR 2.11（95%CI 1.00-4.46）；p=0.049）是显著的危险因素。特别是，尿路感染（p=0.012）和肺炎（p=0.037）与 mFI≥0.27 相关。此外，术后并发症的严重程度与 mFI 呈正相关（p＜0.001）。
mFI 是预测脊柱转移瘤手术术后并发症发生率和严重程度的有用工具。
