124 Multidimensional Approach to Frailty Improves Prediction of Adverse Outcomes in Metastatic Spine Tumor Surgery

Abstract

INTRODUCTION: Surgery for individuals with spinal metastases can have a substantial impact on a patient’s quality of life. Recent research has highlighted the importance of preoperative nutritional status and frailty on outcomes, but little is known about which aspects of malnutrition carry clinical significance. METHODS: Cancer patients who underwent surgery for spinal metastases between August 1, 2014, to March 20, 2019, were stratified by New England Spinal Metastasis Score (NESMS). Frailty was assessed using the Metastatic Spinal Tumor Frailty Index. Nutrition was assessed via the prognostic nutritional index. The primary outcome was overall postoperative survival. Secondary outcomes included 6- and 12-month survival rates, postoperative complication rates, and readmission after surgery. RESULTS: Our study included 154 patients with a mean (SD) age of 63.23 (13.14) years, of whom 94 (61%) were female. 56 patients (36.3%) were classified as NESMS grade 3, while 46 (29.9%) were NESMS 2, 36 (23.4%) were NESMS 1, and (16) 10% were NESMS 0. NESMS 0 group had the highest proportion of severely frail patients (56.2%). Poor nutritional status (PNI < 40.4; Odds ratio; OR 1.87; 95% CI; 0.398-8.82) and increased inflammation (PLR; OR 1.80; 95% CI, 0.766-4.21) were associated with a meaningful increased rate of complications after surgery. Patients with normal nutritional status (AGR, PNI) had a better prognosis than those with poor nutritional status in the same NESMS group. CONCLUSIONS: Malnutrition and severe frailty are associated with high rates of adverse events in high-risk cancer patients with spinal metastases within NESMS prognostic groups. Further work should assess the effectiveness of pre-habilitation programs to improve physiological reserves for patients with spinal metastasis.