A novel online calculator predicting short-term postoperative outcomes in patients with metastatic brain tumors

Abstract

Purpose Establishing predictors of hospital length of stay (LOS), discharge deposition, and total hospital charges is essential to providing high-quality, value-based care. Though previous research has investigated these outcomes for patients with metastatic brain tumors, there are currently no tools that synthesize such research findings and allow for prediction of these outcomes on a patient-by-patient basis. The present study sought to develop a prediction calculator that uses patient demographic and clinical information to predict extended hospital length of stay, non-routine discharge disposition, and high total hospital charges for patients with metastatic brain tumors. Methods Patients undergoing surgery for metastatic brain tumors at a single academic institution were analyzed (2017–2019). Multivariate logistic regression was used to identify independent predictors of extended LOS (> 7 days), non-routine discharge, and high total hospital charges (> $ 46,082.63). p < 0.05 was considered statistically significant. C-statistics and the Hosmer–Lemeshow test were used to assess model discrimination and calibration, respectively. Results A total of 235 patients were included in our analysis, with a mean age of 62.74 years. The majority of patients were female (52.3%) and Caucasian (76.6%). Our models predicting extended LOS, non-routine discharge, and high hospital charges had optimism-corrected c-statistics > 0.7, and all three models demonstrated adequate calibration (p > 0.05). The final models are available as an online calculator ( https://neurooncsurgery.shinyapps.io/brain_mets_calculator/ ). Conclusions Our models predicting postoperative outcomes allow for individualized risk-estimation for patients following surgery for metastatic brain tumors. Our results may be useful in helping clinicians to provide resource-conscious, high-value care.

Validation of an Online Calculator to Predict Short-term Postoperative Outcomes in Patients with Metastatic Brain Tumors

“…Our patient cohort was a similar in number compared to Khalafallah et al's (244 patients vs. 235, respectively) and showed similar demographic pro les, cancer types, and proportion of patients with a solitary BM, supratentorial tumors, and extracranial metastases [9]. Our mean KPS and mFI-5 scores were also similar.…”

“…We replicated the regression analyses presented by Khalafallah et al (Table 2) for BM patients [9]. In these replicated models, independent predictors of extended LOS were non-Caucasian race (OR 5.16, p=0.0037), non-home admission source (OR 8.22, p=0.0003), and KPS (OR 0.93 per 1 point increase, 0.0030) (Table 2).…”

“…We documented the type of procedure performed and where the patient was evaluated post-operatively (ICU versus step-down unit versus intermediate oor status). We collected the data points relevant to the online calculator as mentioned in the Khalafallah et al study (https://neurooncsurgery.shinyapps.io/brain_mets_calculator/), including the patient's preadmission Kanofsky Performance Status Score (KPS), race (Caucasian versus non-Caucasian), marital status, and admission source [9]. To calculate the 5-factor modi ed frailty index (mFI-5), we noted whether the patient had a prior history of hypertension, chronic obstructive pulmonary disease (COPD), or heart failure, as well as if they were dependent with activities of daily living before admission.…”

“…Further, the AUC of the ROC curves for both outcomes were 0.8049 and 0.7512 for extended length of stay and non-routine discharge disposition, respectively (Figure 1g and 1h). 9 . We found high accuracy of the proposed predictive models in our population, which included a greater range of cranial procedures.…”

“…In June 2020, Khalafalleh et al introduced a novel online calculator to predict short-term post-operative outcomes in BM patients [9]. The authors performed a retrospective analysis of independent risk factors focused on high-value care outcomes: extended LOS (>7 days), non-routine discharge disposition (discharge to a facility other than home), and high total hospital charges (>$46,082.63) [9]. Their nal cohort included 235 patients who underwent a craniotomy for tumor resection (n=235, 99.6%) or received a stereotactic biopsy (n=1, 0.4%).…”