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Preoperative Risk Stratification in Spine Tumor Surgery

A Comparison of the Modified Charlson Index, Frailty Index, and ASA Score

Lakomkin, Nikita BA; Zuckerman, Scott L. MD; Stannard, Blaine BA∗∗; Montejo, Julio BA; Sussman, Eric S. MD§; Virojanapa, Justin MD; Kuzmik, Gregory MD; Goz, Vadim MD; Hadjipanayis, Constantinos G. MD, PhD; Cheng, Joseph S. MD, MS||

doi: 10.1097/BRS.0000000000002970

Study Design. A retrospective review of prospectively collected data.

Objective. The purpose of this study is to compare and validate several preoperative scores for predicting outcomes following spine tumor resection.

Summary of Background Data. Preoperative risk assessment for patients undergoing spinal tumor resection remains challenging. At present, few risk assessment tools have been validated in this high-risk population.

Methods. The 2008 to 2014 National Surgical Quality Improvement database was used to identify all patients undergoing surgical resection of spinal tumors, stratified as extradural, intradural extramedullary, and intramedullary based on CPT codes. American Society of Anesthesiologists (ASA) score, modified Charlson Comorbidity Index (CCI), and modified Frailty Index (mFI) were computed. A binary logistic regression model was used to explore the relationship between these variables and postoperative outcomes, including mortality, major and minor adverse events, and hospital length of stay (LOS). Other significant variables such as demographics, operative time, and tumor location were controlled for in each model.

Results. Two thousand one hundred seventy patients met the inclusion criteria. Higher CCI scores were independent predictors of mortality (OR = 1.24, 95% CI: 1.14–1.36, P < 0.001), major adverse events (OR = 1.07, 95% CI: 1.01–1.31, P = 0.018), minor adverse events (OR = 1.15, 95% CI: 1.10–1.20, P < 0.001), and prolonged LOS (OR = 1.14, 95% CI: 1.09–1.19, P < 0.001). Patients’ mFI scores were significantly associated with mortality and LOS, but not major or minor adverse events. ASA scores were not associated with any outcome metric when controlling for other variables.

Conclusion. The CCI demonstrated superior predictive capacity compared with mFI and ASA scores and may be valuable as a preoperative risk assessment tool for patients undergoing surgical resection of spinal tumors. The validation of assessment scores is important for preoperative risk stratification and improving outcomes in this high-risk group.

Level of Evidence: 3

Several preoperative scores were compared and validated for patients undergoing spine tumor resection. The Charlson Index demonstrated superior predictive capacity compared with modified frailty and American Society of Anesthesiologists scores and may be valuable as a preoperative risk assessment tool for patients undergoing surgical resection of spinal tumors.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY

Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN

Department of Neurosurgery, Yale School of Medicine, Yale, CT

§Department of Neurosurgery, Stanford University, Stanford, CA

Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT

||Department of Neurosurgery, University of Cincinnati, Cincinnati, OH

∗∗Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

Address correspondence and reprint requests to Nikita Lakomkin, BA, 1 Gustave L. Levy Place, New York, NY 10029; E-mail:

Received 5 October, 2018

Revised 19 November, 2018

Accepted 6 December, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.