Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Length of Stay After Spine Surgery

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• 作者：Rafael De la Garza Ramos¹ ; C. Rory Goodwin¹ ; Amit Jain² ; Nancy Abu-Bonsrah¹ ; Charles G. Fisher³ ; Chetan Bettegowda¹ ; Daniel M. Sciubba¹ ; ^{dsciubb1@jhmi.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cancer ; Frailty ; Frailty index ; Metastasis ; Spinal metastatic tumor ; Spine surgery
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：95
• 期：Complete
• 页码：548-555.e4
• 全文大小：1186 K

文摘

The aim of this study was to develop a perioperative metastatic spinal tumor frailty index (MSTFI) that could predict morbidity, mortality, and length of stay.

Methods

A large inpatient hospitalization database was searched from 2002 to 2011 to identify 4583 patients with spinal metastasis from breast (21.1%), lung (34.1%), thyroid (3.8%), renal (19.9%), and prostate (21.1%) cancer who underwent surgery. A multiple logistic regression model identified 9 independent parameters that were used to construct the MSTFI: anemia, chronic lung disease, coagulopathy, electrolyte abnormalities, pulmonary circulation disorders, renal failure, malnutrition, emergent/urgent admission, and anterior/combined surgical approach. Patients with 0 points were categorized as “not frail,” 1 as “mildly frail,” 2 as “moderately frail,” and ≥3 as “severely frail.”

Results

The overall perioperative complication rate was 19.3% and in-patient mortality was 3.0%. Compared with patients with no frailty, patients with moderate frailty (odds ratio [OR] 5.15; 95% confidence interval [95% CI] 2.44–10.86), and severe frailty (OR 5.74; 95% CI 2.69–12.24) had significantly increased odds of inpatient mortality (all P < 0.001). Similarly, patients with mild frailty (OR 1.88; 95% CI 1.33–2.66), moderate frailty (OR 3.83; 95% CI 2.71–5.41), and severe frailty (OR 6.97; 95% CI 4.98–9.74) had significantly increased odds of developing a major in-hospital complication (all P < 0.001). Length of stay also increased significantly by MSTFI (P < 0.001).

Conclusions

In surgically treated patients with spinal metastasis, certain perioperative parameters may significantly predict the risk of major in-hospital complications and mortality.