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Neurospine > Volume 19(1); 2022 > Article |
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Funding/Support
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author Contribution
Conceptualization: SFK, AD, CB, WC, RT, DAC, OT, KC, RM, CC, MS; Data curation: SFK, CB, RM, CC, MS; Formal analysis: SFK, AD, CB, SS, RT, DAC, MC, OT, JV, KC, CR, PS, MS; Funding acquisition: C Bowers, WC, RM, MS; Methodology: SFK, AD, CB, SS, WC, RT, DAC, MC, OT, JV, KC, JD, RM, CR, PS, CC, MS; Project administration: CB, WC, MS; Visualization: SFK, AD, CB, SS, WC, RT, DAC, JV, JD, CR, PS, MS; Writing - original draft: SFK, AD, CB, SS, WC, RT, DAC, MC, OT, JV, KC, JD, CR, PS, MS; Writing - review & editing: SFK, AD, CB, WC, RT, DAC, OT, KC, JD, RM, CR, PS, MS.
NSQIP variable | mFI-5 score* |
---|---|
Non-independent functional status† | 1 |
Diabetes mellitus with oral agents or insulin | 1 |
Chronic obstructive pulmonary disease | 1 |
Hypertension requiring medication | 1 |
Congestive heart failure | 1 |
Maximum score | 5 |
Variable | Value |
---|---|
Age (yr)† | 59 (47–68) |
Age groups (yr)† | |
18–20 | 46 (0.98) |
21–30 | 304 (6.5) |
31–40 | 457 (9.8) |
41–50 | 630 (13.5) |
51–60 | 1,092 (23.4) |
61–70 | 1,200 (25.7) |
71–80 | 731 (15.7) |
> 80 | 185 (4) |
Sex, male:female | 2,470 (53):2,192 (47) |
Body mass index (kg/m2) | 18.99 (16.26–22.05) |
Tumor location | |
Extradural | 2,177 (46.7) |
Intradural extramedullary | 1,918 (41.1) |
Intramedullary | 567 (12.2) |
Tumor type | |
Primary | 1,755 (37.6) |
Secondary | 2,020 (43.3) |
Unknown | 887 (19) |
Distribution of frailty | |
Not frail (mFI-5 = 0) | 2,351 (50.4) |
Prefrail (mFI-5 = 1) | 1,608 (34.8) |
Frail (mFI-5 = 2) | 614 (13.2) |
Severely frail (mFI-5 ≥ 3) | 89 (1.9) |
Preoperative clinical status/comorbidities | |
Functionally dependent | 340 (7.3) |
Diabetes mellitus | 639 (13.7) |
COPD | 171 (3.7) |
CHF | 18 (0.4) |
Current smoker | 793 (17) |
Dyspnea | 177 (3.8) |
Hypertension | 1,944 (41.7) |
Disseminated cancer | 1,344 (28.8) |
Open wound | 63 (1.4) |
Steroid use | 459 (9.8) |
Weight loss | 136 (2.9) |
Bleeding disorders | 164 (3.5) |
Preoperative transfusion | 50 (1.1) |
Preop SIRS | 180 (3.9) |
Operative time (hr) | 187 (133–261) |
Length of stay (day) | 5 (3–9) |
Mortality | 53 (1.6) |
Readmission | 435 (9.3) |
Reoperation | 239 (5.1) |
Major postoperative complications | 495 (10.6) |
Prolonged intubation (≥ 48 hr) | 5 (0.1) |
Unplanned reintubation | 57 (1.2) |
Sepsis | 91 (2) |
Septic shock | 30 (0.6) |
Pneumonia | 107 (2.3) |
DVT/thrombophlebitis | 94 (2) |
Pulmonary embolism | 63 (1.4) |
CVA/stroke with neurological deficit | 21 (0.5) |
Acute renal failure | 9 (0.2) |
Myocardial infarction | 18 (0.4) |
Cardiac arrest requiring CPR | 17 (0.4) |
Superficial SSI | 63 (1.4) |
Deep incisional SSI | 31 (0.7) |
Organ space SSI | 52 (1.1) |
Wound disruption | 28 (0.6) |
Minor postoperative complications | 726 (15.6) |
Intra-/postoperative blood transfusion | 588 (12.6) |
Renal insufficiency | 9 (0.2) |
Urinary tract infection | 163 (3.5) |
Discharge destination | |
Home | 3,000 (64.4) |
Nonroutine (including expired, rehab, SNF, and others) | 1,624 (34.8) |
Unknown | 38 (0.8) |
Values are presented as median (interquartile range) or number (%).
NSQIP, National Surgical Quality Improvement Project; mFI-5, modified frailty index-5; COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure; SIRS, systemic inflammatory response syndrome; DVT, deep venous thrombosis; CVA, cerebrovascular accident; CPR, cardiopulmonary resuscitation; SSI, surgical site infection; SNF, skilled nursing facility.
Variable | Mortality | Major complication | Unplanned readmission | Reoperation | Hospital LOS | Discharge to nonhome destination | |
---|---|---|---|---|---|---|---|
Age | 1.02 (0.99–1.04)* | 1.03 (1.00–1.04)* | 0.99 (0.99–1.03) | 0.99 (0.98–1.00)* | 0.02 (0.01–0.03)* | 1.03 (1.02–1.03)* | |
Frailty status (mFI-5) | |||||||
Prefrail | 1.38 (0.71–2.7)* | 1.58 (0.92–2.72)* | 1.29 (1.03–1.62)* | 1.39 (1.04–1.84)* | 1.24 (1.09–1.67)* | 1.56 (1.36–1.79)* | |
Frail | 5.73 (3.12–10.52)* | 2.14 (1.27–3.61)* | 1.77 (1.33–2.34)* | 1.10 (0.73–1.68) | 1.89 (1.32–2.13)* | 2.52 (2.10–3.02)* | |
Severely frail | 20.2 (9.40–43.4)* | 3.09 (1.86–5.16)* | 1.78 (0.92–3.4)* | 2.13 (1.01–4.53)* | 3.01 (2.15–4.35)* | 2.00 (1.30–3.07)* |
mFI-5, modified frailty index-5; NSQIP, National Surgical Quality Improvement Project; LOS, length of stay.
† The effect of age and mFI-5 were each analyzed by univariate analyses using simple logistic regression for dichotomous outcomes or linear regression for continuous outcomes. Effect sizes were summarized by odds ratio (dichotomous outcomes) or beta coefficients (continuous outcomes) and associated 95% confidence intervals (95% confidence interval).
Variable | Mortality | Major complication | Unplanned readmission | Reoperation | Hospital LOS | Discharge to nonhome destination | |
---|---|---|---|---|---|---|---|
Age | 1.01 (0.91–1.020)* | 1.00 (0.96–1.011)* | 1.00 (0.976–1.012)* | 0.91 (0.85–0.96)* | 0.02 (0.01–0.03)* | 1.02 (0.98–1.03)* | |
mFI-5 | |||||||
Prefrail | 1.31 (0.85–2.15)* | 1.62 (0.98–2.23)* | 1.23 (1.01–1.59)* | 1.32 (1.01–1.82)* | 1.21 (1.01–1.39)* | 1.52 (1.33–1.75)* | |
Frail | 4.01 (3.34–9.12)* | 2.20 (1.43–3.32)* | 1.74 (1.21–2.04)* | 1.06 (0.83–1.54) | 1.91 (1.42–2.19)* | 2.48 (2.15–2.98)* | |
Severely frail | 16.4 (11.21–35.44)* | 3.02 (1.97–4.56)* | 1.76 (0.88–3.7)* | 2.07 (1.00–4.17)* | 2.94 (2.32–4.21)* | 1.91 (1.25–2.88)* |
mFI-5, modified frailty index-5; NSQIP, National Surgical Quality Improvement Project; LOS, length of stay.
† The multivariate model was controlled for covariates: sex, body mass index, tumor location, tumor type, and operative time. The effect of age and mFI-5 were evaluated in a multivariate model using simple logistic regression for dichotomous outcomes or linear regression for continuous outcomes. Effect sizes were summarized by odds ratio (dichotomous outcomes) or beta coefficients (continuous outcomes) and associated 95% confidence intervals.