Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients

医学 接收机工作特性 置信区间 优势比 多元分析 单变量分析 虚弱指数 曲线下面积 单变量 内科学 多元统计 外科 数学 统计
作者
Syed Faraz Kazim,Alis J. Dicpinigaitis,Christian A. Bowers,Smit Shah,William T. Couldwell,Rachel Thommen,Daniel J. Alvarez-Crespo,Matthew Conlon,Omar Tarawneh,John Vellek,Kyrill L. Cole,Jose F. Dominguez,Rohini McKee,Christian B. Ricks,Peter Shin,Chad Cole,Meic H. Schmidt
出处
期刊:Neurospine [Korean Spinal Neurosurgery Society]
卷期号:19 (1): 53-62 被引量:14
标识
DOI:10.14245/ns.2142770.385
摘要

The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry.The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients' data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5.Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. 'Severely frail' patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21-35.44) for 30-day mortality, 3.02 (95% CI, 1.97-4.56) for major complications, and 2.94 (95% CI, 2.32-4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality.Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.
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