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  • Development Of A Preoperative Metastatic Spinal Tumor Frailty Index (MSTFI) Using A Nationwide Database and its Association With Inpatient Morbidity, Mortality, and Length of Stay

    Final Number:

    C. Rory Goodwin MD PhD; Rafael De la Garza-Ramos BA; Amit Jain BS; Nancy A Abu-Bonsrah BS; Charles Fisher MD; Chetan Bettegowda MD, PhD; Daniel M. Sciubba BS, MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: “Frailty”, a state of decreased homeostatic reserve, may be estimated based on the presence of preoperative comorbidities. The aim of this study was to develop a preoperative metastatic spinal tumor frailty index (MSTFI) which could predict morbidity, mortality, and length of stay.

    Methods: A large inpatient hospitalization database was searched from 2002-2011 to identify 4,583 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 nine independent parameters that were used to construct the MSTFI: anemia, congestive heart failure, chronic lung disease, coagulopathy, electrolyte abnormalities, pulmonary circulation disorders, renal failure, malnutrition, and pathologic fractures. Patients with 0 comorbidities 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 to patients without frailty, patients with mild (odds ratio (OR) 2.12; 95% CI, 1.74 – 2.59), moderate (OR 3.81; 95% CI, 3.05 – 4.76), and severe frailty (OR 8.11; 95% CI, 6.34 – 10.38) had significantly increased odds of complication development. Likewise, patients with mild (OR 2.73; 95% CI, 1.64 – 4.52), moderate (OR 4.10; 95% Ci, 2.39 – 7.04), and severe frailty (OR 6.34; 95% CI, 3.61 – 11.1) were more likely to die during their hospital stay. Length of stay also increased significantly by MSTFI (p<0.001).

    Conclusions: In surgically treated patients with spinal metastasis, certain preoperative comorbidities may significantly increase the risk of major complications and mortality.

    Patient Care: Spinal metastatic disease is increasing in incidence. Identifying risk factors for morbidity, mortality and length of stay is important in appropriately stratifying patients for treatment

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify factors that are associated with morbidity, mortality and length of stay among patients with metastatic spine tumors

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