Neurospine.
2022 Mar;19(1):53-62. 10.14245/ns.2142770.385.
Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients
- Kazim SF
1 - Dicpinigaitis AJ2
- Bowers CA1
- Shah S3
- Couldwell WT4
- Thommen R2
- Alvarez-Crespo DJ5
- Conlon M2
- Tarawneh OH2
- Vellek J2
- Cole KL6
- Dominguez JF7
- Mckee RN8
- Ricks CB1
- Shin PC1
- Cole CD1
- Schmidt MH1
- Affiliations
-
- 1Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
- 2School of Medicine, New York Medical College, Valhalla, NY, USA
- 3Department of Neurology, Prisma Health–Midlands/University of South Carolina School of Medicine, Columbia, SC, USA
- 4Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- 5School of Medicine, University of Panama, Panama City, Panama
- 6School of Medicine, University of Utah, Salt Lake City, UT, USA
- 7Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, USA
- 8Department of Surgery, University of New Mexico, Albuquerque, NM, USA
- KMID: 2528377
- DOI: http://doi.org/10.14245/ns.2142770.385
Abstract
Objective
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.
Methods
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.
Results
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.
Conclusion
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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