Spinal tumor surgery risk index may have high predictive performance for adverse events
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PHILADELPHIA — Preoperative use of a spinal tumor surgery risk index in patients undergoing spinal tumor surgery had a high predictive performance for major postoperative adverse events and death, according to results presented here.
“The models that are available now are great. We believe this one will also add to the accuracy of these models,” Safwan Alomari, MD, of the department of neurosurgery at Johns Hopkins University School of Medicine, told Healio about a study he presented at the American Association of Neurological Surgeons Annual Meeting. “Also, we can identify the patients who are at risk for developing these adverse outcomes and then we can optimize the patient’s status before the surgery. So, I think this can help in the patient care directly.”
Alomari and colleagues analyzed prospectively collected data of patients undergoing spinal tumor surgery from multiple medical centers registered in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) during 2006 to 2019. Researchers used simple and multiple logistic regression to evaluate sociodemographic, frailty-related and surgical factors in the derivation cohort, and subsequently integrated risk factors into a preoperative spinal tumor surgery risk index, which was compared with existing models using a validation cohort. Researchers performed internal validation of the final model on a subgroup of patients from the ACS-NSQIP. External validation was performed on an institutional cohort from Johns Hopkins Hospital.
“After developing the score and validating it, the accuracy of predicting the outcomes was high,” Alomari said. “The accuracy of the model outperforms the currently available models to predict the outcome in this population of patients.”
Alomari noted a total of 22 predictors were statistically and clinically associated with major adverse events or death after surgery for spinal tumors. Factors independently associated with major adverse events or death included older age, male sex, Black race, smoking, steroid use, anticoagulation use, leukocytosis, anemia, disseminated cancer, weight loss, hypoalbuminemia, functional status, intradural intramedullary plane of the tumor, metastatic tumor, cervical or thoracic level of the surgery, combined anterior and posterior approach and operative time of more than 4 hours, according to multiple regression analysis.
“There is always room for improvement and with the advancement of statistical methods, machine learning and other tools to develop predictive models, as well as the increase in the collection of databases nationwide, we are expecting with time that there will be more improvement in the scores,” Alomari said.
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Alomari S, et al. Evaluation of a preoperative adverse event risk index for patients undergoing spinal tumor surgery. Presented at: American Association of Neurological Surgeons Annual Meeting. April 29 - May 2, 2022; Philadelphia.
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