Predicting 30-day mortality after surgery for metastatic disease of the spine: the H2-FAILS score.

P38. Predicting 30-day mortality after surgery for metastatic disease of the spine: the H2-FAILS score

Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS)

Predictive factors of the 30-day mortality after surgery for spinal metastasis: Analysis of a nationwide database

Patients presenting with neurological deficits and/or pain due to spinal metastasis usually require immediate or subacute surgical treatment. Nevertheless, it is unclear whether or not side effects of primary cancer location might influence postoperative complication rate. We therefore analyzed our spinal database to identify factors influencing early postoperative complications after surgery for symptomatic spinal metastases. From 2013 to 2017, 163 consecutive patients suffering from symptomatic spinal metastases were treated at our department. Early postoperative complications were defined as any postoperative event requiring additional medical or surgical treatment within 30days of spinal surgery. A multivariate regression analysis was performed to identify independent predictors for postoperative complications after surgery for spinal metastasis. Overall, 39 of 163 patients who underwent spinal surgery for spinal metastasis developed early postoperative complications throughout the treatment course (24%). Preoperative ASA score ≥ 3 (p = 0.003), preoperative C-reactive protein level > 10mg/l (p = 0.008), preoperative Karnofsky Performance Score < 60% (p = 0.03), radiation treatment within 2months of surgery (p = 0.01), presence of diabetes mellitus (p = 0.008), and preoperative complete neurological impairment (p = 0.04) were significant and independent predictors for early postoperative complications in patients with surgery for spinal metastasis. The ability to preoperatively predict postoperative complication risk is valuable to select critically ill patients at higher risk requiring special attention. Therefore, the present study identified several significant and independent risk factors for the development of early postoperative complication in patients who underwent surgery for spinal metastasis.

The Geriatric Nutritional Risk Index (GNRI) is commonly used to assess malnutrition risk in elderly patients, but its impact on spine surgery for metastatic spinal tumors is not well understood. This study aimed to evaluate the associations between preoperative nutritional status, as measured by the GNRI, and postoperative morbidity and mortality in elderly patients undergoing spine surgery for metastatic spinal tumors. A retrospective cohort study was performed using the 2011-2022 National Surgical Quality Improvement Program database of the American College of Surgeons. Elderly (≥ 65 years of age) patients undergoing laminectomy or corpectomy for extradural spinal tumor metastases were identified using International Classification of Diseases, 9th and 10th Revision and Current Procedural Terminology codes. Patients with missing data on sex, preoperative albumin, height, or weight were excluded. The study population was categorized by GNRI score: normal, malnourished, or severely malnourished. Using receiver operating characteristic (ROC) and multivariable analyses, the authors compared the discriminative thresholds and independent associations of GNRI, the 5-item modified frailty index (mFI-5), and older patient age with any adverse event (AE), extended hospital length of stay (LOS), nonroutine discharge, and 30-day mortality. Of the 659 patients identified, 277 (42.0%) had normal nutritional status, 163 (24.7%) were malnourished, and 219 (33.2%) were severely malnourished. The severely malnourished cohort had significantly increased proportions of electrolyte abnormalities (p = 0.019) and anemia (p < 0.001), with a significant decrease in BMI and albumin levels across cohorts (p < 0.001). Malnourished and severely malnourished patients had significantly longer LOS (9.1 ± 6.2 days and 12.5 ± 8.6 days, respectively, vs 8.6 ± 7.1 days for patients categorized as normal, p < 0.001) and nonroutine discharge (57.9% and 66.7%, respectively, vs 39.7% for normal, p < 0.001). The severely malnourished cohort had significantly increased 30-day mortality (17.4% vs 6.5% for normal and 13.5% for malnourished, p = 0.001). On multivariable analysis, severely malnourished status was independently associated with any AE (adjusted odds ratio [aOR] 1.59, p = 0.036), extended LOS (aOR 2.17, p = 0.001), nonroutine discharge (aOR 1.99, p = 0.001), and 30-day mortality (aOR 2.28, p = 0.013). Malnourished status was independently associated with nonroutine discharge (aOR 1.84, p = 0.005). In ROC analysis, GNRI outperformed the mFI-5 (p = 0.318, p = 0.031, p < 0.009, and p = 0.026, respectively) and patient age (p = 0.018, p < 0.001, p = 0.014, and p = 0.034, respectively) in predicting 30-day AEs, extended LOS, nonroutine discharge, and 30-day mortality. This study suggests that preoperative GNRI-defined malnutrition is associated with a higher risk of adverse postoperative outcomes in elderly patients undergoing spine surgery for metastatic spinal tumors.

Predictive value of hypoalbuminemia and severe hypoalbuminemia in oncologic spine surgery

Updated external validation of the SORG machine learning algorithms for prediction of ninety-day and one-year mortality after surgery for spinal metastasis

40. Surgical Site Infection in Spinal Metastasis - Risk Factor and Countermeasure

BackgroundTherapeutic decision-making regarding surgical treatment of spinal metastasis is supported by clinical characteristics that are potentially predictive of postoperative events. The predictive power of total lymphocyte count (TLC) in peripheral blood has not been elucidated for this type of surgery. Therefore, the aim of this study was to assess the capacity of TLC to predict 30-day morbidity and mortality following surgery for spinal metastases. MethodsThis is a level III prognostic study, which consists of a retrospective review of records from a cancer referral hospital. Consecutive patients who underwent open surgery for spinal metastatic disease were studied. Outcomes of interest were 30-day post-op mortality and complications. The patients were divided into three groups based on preoperative TLC: low, moderate, and high risk for surgery, according to a discriminatory power analysis. The predictive power of TLC was compared to that of other known predictors, i.e., older age, tumor aggressiveness, and presence of comorbidities. Odds ratios (ORs) and 95% confidence intervals were calculated using bivariate and multivariate analyses. ResultsIn total, 205 patients underwent surgery. Thirty-day mortality and occurrence of complications were 17% and 31%, respectively. The discriminatory power of TLC was 71% and 68% for 30-day survival and complications, respectively. In multivariate analysis, the strongest relationship between predictors and postoperative morbidity and mortality concerned TLC < 800 cells/µL, which was associated with decreased likelihood of 30-day survival (OR 3.17) and increased likelihood of complications (OR 3.93). Incidence of 30-day mortality and complications by risk group was, respectively: 4% and 13% for low risk (TLC > 1857 cells/µL); 22% and 34% for moderate risk (TLC 800-1857 cells/µL); and 35% and 56% for high risk (TLC < 800 cells/µL). ConclusionsTLC is a strong predictor of 30-day morbidity and mortality following spinal metastasis surgery. It may be useful for improving patient care and planning personalized treatments.

In hip fracture patients with elevated international normalized ratios (INRs), the risks of delaying surgery for correction of INR are controversial. We examined the association of (1) preoperative INR values and (2) surgical delay with postoperative complications after intramedullary nailing of hip fractures. Using the National Surgical Quality Improvement Program database, we retrospectively identified patients that underwent intramedullary nailing for hip fractures from 2005 to 2016. Patients aged older than 55 years with preoperative INR recorded ≤1 day before surgery were included. Patients were stratified into five cohorts-(1) INR ≤ 1.0, (2) 1 < INR ≤ 1.25 (INR [1 to 1.25]), (3) 1.25 < INR ≤ 1.5 (INR [1.25 to 1.5]), (4) 1.5 < INR ≤ 2.0 (INR [1.5 to 2.0]), and (5) INR > 2.0. The primary outcomes of interest were postoperative bleeding requiring transfusion, surgical site infection, and 30-day mortality. Multivariate regression analysis was done to adjust for potential confounding variables. In total, 15,323 patients were included in this analysis. Adjusting for potential confounders, INR [1 to 1.25], INR [1.25 to 1.5], and INR [1.5 to 2.0] were associated with increased mortality (adjusted odds ratio [aOR]: 1.501, P < 0.001; aOR: 2.226, P < 0.001; aOR: 2.524, P < 0.001, respectively) and surgical delay >48 hours (aOR: 1.655, P < 0.001; aOR: 3.434, P < 0.001; aOR: 2.382, P < 0.001, respectively). The INR > 2.0 cohort was not associated with mortality (P = 0.181) or surgical delay (P = 0.529). Surgical delay was associated with mortality (aOR: 1.531, P = 0.004). The INR > 2.0 cohort was associated with increased rate of transfusions (aOR: 1.388, P = 0.039). Elevated preoperative INR value within 1 day of surgery between 1.0 and 2.0 was associated with increased risk of 30-day mortality and surgical delay >48 hour, which may represent attempts at INR correction. An INR greater than 2.0 was not associated with mortality or surgical delay but was associated with increased transfusions. Surgical delay was independently associated with increased risk of 30-day mortality. We therefore recommend that INR reversal be attempted but not delay surgical fixation of geriatric hip fractures over 48 hours and counsel patients and their families regarding the risks of surgery with elevated INR. Prognostic-level III/retrospective cohort study.

Study DesignRetrospective Cohort Study.ObjectivesTo evaluate the predictive performance of the Risk Analysis Index (RAI) and Modified 5-Item Frailty Index (mFI-5) in identifying risk for adverse postoperative outcomes in patients undergoing occipitocervical fusion (OCF).MethodsThe American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent OCF from 2015 to 2020. Frailty was measured using both the RAI and mFI-5. The primary outcome was 30-day mortality. Secondary outcomes included major complications, minor complications, unplanned readmission, extended length of stay (eLOS), and non-home discharge (NHD). Multivariable logistic regression was used to assess associations, while receiver operating characteristic (ROC) curve analysis evaluated model discrimination.ResultsA total of 1637 patients were included (median age 68 years; 51.4% male). Higher frailty scores on both RAI and mFI-5 were associated with increased odds of mortality, major complications, and NHD. However, the RAI demonstrated superior discrimination for predicting mortality (C-statistic: 0.79 [95% CI: 0.75-0.83]) compared to mFI-5 (0.57 [95% CI: 0.53-0.61], P < .001), as well as for major complications (RAI: 0.64 vs mFI-5: 0.57, P = .01) and NHD (RAI: 0.73 vs mFI-5: 0.65, P < .001).ConclusionsThe RAI outperformed the mFI-5 in predicting key adverse outcomes following OCF. Incorporating RAI into preoperative evaluation may improve frailty-based risk stratification and guide surgical decision-making in vulnerable patients.

Compliance to an enhanced recovery pathway among patients with a high frailty index after major gastrointestinal surgery results in improved 30-day outcomes

Estimatedpostoperative survival is an important consideration during the decision-making process for patients with spinal metastases. Nutritional status has been associated with poor outcomes and limited survival in the general cancer population. The objective of this study was to evaluate the predictive utility of the prognostic nutritional index (PNI) for postoperative mortality after spinal metastasis surgery. A total of 139 patients who underwent oncologic surgery for spinal metastases between April 2012 and August 2022 and had a minimum 90-day follow-up were included. PNI was calculated using preoperative serum albumin and total lymphocyte count, with PNI < 40 defined as low. The mean PNI of our cohort was 43 (standard deviation: 7.7). The primary endpoint was 90-day mortality, and the secondary endpoint was 12-month mortality. Multivariate logistic regression analyses were performed. The 90-day mortality was 27% (37/139), and the 12-month mortality was 56% (51/91). After controlling for age, ECOG performance status, total psoas muscle cross-sectional area (TPA), and primary cancer site, thePNI was associated with 90-daymortality [odds ratio 0.86 (95% confidence interval 0.79-0.94); p = 0.001]. After controlling for ECOG performance status and primary cancer site, the PNI was associated with 12-month mortality [OR 0.89 (95% CI 0.82-0.97); p = 0.008]. Patients with a low PNI had a 50% mortality rate at 90days and an 84% mortality rate at 12months. The PNI was independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery, independent of performance status, TPA, and primary cancer site.

P30. Sarcopenia independently and accurately predicts survival in patients undergoing spine surgery for metastatic tumors: a multicenter retrospective cohort study

INTRODUCTION Subdural hematoma (SDH) evacuation is a common neurosurgical procedure with high risk for morbidity and mortality. The purpose of this study was to develop a risk score for 30-day mortality following SDH evacuation on the basis of readily available pre-operative information. METHODS Data recorded in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database between 2006 and 2014 were selected on the basis of ICD-9 (International Classification of Diseases, Ninth ed.) and CPT (Current Procedural Terminology) coding. Sequential univariate and multivariate analyses were used to identify significant independent predictors of 30-day mortality among 32 pre- operative factors. Multivariate regression coefficients were used to develop a weighted risk score capable of separating outcome groups with high sensitivity and specificity. RESULTS &gt;Following list-wise exclusion of patients with incomplete datasets, 1271 patients (35.6% F; median age 73.0 years, IQR 44.1-89.0 years) were examined. Sequential univariate and multivariate analysis identified seven independent predictors of 30-day mortality (OR = adjusted odds ratio): emergency case (OR 2.27), age &gt;= 65 years (OR 2.42), ventilator dependent status (OR 4.95), dialysis (OR 5.16), bleeding disorder (OR 2.37), WBC count &gt;= 10,000 mu;L-1 (OR 1.79), and platelets &lt;150,000 μL-1 (OR 2.18). Receiver operating characteristic (ROC) analysis demonstrated impressive outcome discrimination (area under the curve = 0.82, CI 5–95% = 0.78 0.86). Optimal score threshold was used to identify high-risk (mortality 35.0%) and low-risk (mortality 6.33%) patient groups. CONCLUSION We demonstrate a novel risk score capable of classifying patients based on 30-day postsurgical mortality. Application will provide an improved means of predicting outcomes for patients undergoing craniotomy or craniectomy for SDH evacuation.