Hospital-acquired infection following spinal tumor surgery: A frailty-driven pre-operative risk model

Kassicieh, Christian S.; Kassicieh, Alexander J.; Rumalla, Kavelin; Courville, Evan; Cole, Kyril L.; Kazim, Syed Faraz; Bowers, Christian A.; Schmidt, Meic H.

doi:10.1016/j.clineuro.2023.107591

Cited by 4 publications

(9 citation statements)

References 35 publications

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“…20,21,33,34 The RAI has been found to be useful and effective for surgical risk strati cation, particularly due to its predictive value and ease of integration into preoperative routines. 17,20,35,36 The RAI can assist healthcare professionals in identifying at-risk patients that may bene t from tailored interventions and personalized care plans. 17,20,35,36 In addition, preoperative frailty risk strati cation provides a unique opportunity to mitigate risk of adverse patient outcomes and decrease healthcare expenditure.…”

Section: Discussionmentioning

confidence: 99%

“…17,20,35,36 The RAI can assist healthcare professionals in identifying at-risk patients that may bene t from tailored interventions and personalized care plans. 17,20,35,36 In addition, preoperative frailty risk strati cation provides a unique opportunity to mitigate risk of adverse patient outcomes and decrease healthcare expenditure. 17,20,35,36 This retrospective study has several limitations that need to be considered when interpreting our results.…”

Section: Discussionmentioning

confidence: 99%

“…17,20,35,36 In addition, preoperative frailty risk strati cation provides a unique opportunity to mitigate risk of adverse patient outcomes and decrease healthcare expenditure. 17,20,35,36 This retrospective study has several limitations that need to be considered when interpreting our results.…”

Section: Discussionmentioning

confidence: 99%

“…A vast amount of literature has been published about the data structure of the ACS-NSQIP. 17,18 After reviewing relevant information, we identi ed 149 163 patients classi ed as obese who were ≥ 18 years old and underwent spine surgeries between 2012 and 2020. The study was approved by the University of New Mexico's Institutional Review Board and was conducted in accordance with the guidelines outlined in the ACS-NSQIP data use agreement.…”

Section: Data and Study Participantsmentioning

confidence: 99%

“…Brie y, the RAI and mFI-5 are two frailty risk assessment tools used to guide decision-making and to risk stratify surgical treatment recommendations for frail patients considering surgery. [17][18][19][20][21] Therefore, we sought to compare the discriminatory thresholds of these two frailty riskassessment tools and patient age. In addition, we evaluated their independent relationship with 30-day postoperative mortality.…”

Section: Introductionmentioning

confidence: 99%

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Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic

Owodunni,

Courville,

Peter-Okaka

et al. 2023

Int J Obes

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Background/ObjectivesObesity is a global health challenge that affects > 1/3 adults worldwide. Obesity and frailty pose considerable health risks due to their potential to interact and amplify one another's negative effects.Therefore, we sought to compare the discriminatory thresholds and independent relationship of the risk analysis index (RAI), 5-factor modi ed frailty index (m-FI-5) and greater patient age for the primary endpoint of 30-day postoperative mortality. Subjects/MethodsWe included spine surgery patients ≥ 18 years old, from the American College of Surgeons National Quality Improvement program database from 2012-2020, that were classi ed as obese. We performed receiver operating characteristic curve analysis to compare the discrimination threshold of RAI, mFI-5, and patient age for 30-day postoperative mortality. Risk-adjusted analyses were performed. ResultsOverall, there were 149 163 patients evaluated, and in the ROC analysis for 30-day postoperative mortality, RAI showed superior discrimination C-statistic 0.793 (95% CI: 0.773-0.813), compared to mFI-5 C-statistic 0.671 (95% CI 0.650-0.691), and patient age C-statistic 0.686 (95% CI 0.666-0.707). By subgroups for obesity class I-III, consistent results were observed (C-statistics range: RAI 0.767-0.808; mFI-5 0.642-0.693; patient age 0.665-0.706). In the risk-adjusted analyses, frailty had a dose-dependent relationship with 30-day postoperative mortality, and the RAI had a larger effect size (p<0.001).Additionally, obesity and frailty had a synergistic dose-dependent relationship across obesity class I-III (p<0.001). ConclusionIn this study of 149 163 patients classi ed as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting 30-day postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data and Study Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic

Owodunni,

Courville,

Peter-Okaka

et al. 2023

Int J Obes

View full text Add to dashboard Cite

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Causes and Predictors of Unplanned Readmission in Patients Undergoing Intracranial Tumor Resection: A Multicenter Analysis of 31,776 Patients

Zohdy,

Skandalakis,

Kassicieh

et al. 2023

World Neurosurgery

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Frailty Predicts 30-day Mortality in Spine Surgery Patients Classified as Obese and the Risk Analysis Index Exhibits Excellent Discrimination

Owodunni

Courville

Okakpu

et al. 2023

Preprint

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Background/Objectives Obesity is a global health challenge that affects > 1/3 adults worldwide. Obesity and frailty pose considerable health risks due to their potential to interact and amplify one another’s negative effects. Therefore, we sought to compare the discriminatory thresholds and independent relationship of the risk analysis index (RAI), 5-factor modified frailty index (m-FI-5) and greater patient age for the primary endpoint of 30-day postoperative mortality. Subjects/Methods We included spine surgery patients ≥ 18 years old, from the American College of Surgeons National Quality Improvement program database from 2012-2020, that were classified as obese. We performed receiver operating characteristic curve analysis to compare the discrimination threshold of RAI, mFI-5, and patient age for 30-day postoperative mortality. Risk-adjusted analyses were performed. Results Overall, there were 149 163 patients evaluated, and in the ROC analysis for 30-day postoperative mortality, RAI showed superior discrimination C-statistic 0.793 (95% CI: 0.773-0.813), compared to mFI-5 C-statistic 0.671 (95% CI 0.650-0.691), and patient age C-statistic 0.686 (95% CI 0.666-0.707). By subgroups for obesity class I-III, consistent results were observed (C-statistics range: RAI 0.767-0.808; mFI-5 0.642-0.693; patient age 0.665-0.706). In the risk-adjusted analyses, frailty had a dose-dependent relationship with 30-day postoperative mortality, and the RAI had a larger effect size (p<0.001). Additionally, obesity and frailty had a synergistic dose-dependent relationship across obesity class I-III (p<0.001). Conclusion In this study of 149 163 patients classified as obese and undergoing spine procedures in an international prospective surgical database, the RAI demonstrated superior discrimination compared to the mFI-5 and patient age in predicting 30-day postoperative mortality risk. The deleterious effects of frailty and obesity were synergistic as their combined effect predicted worse outcomes.

show abstract

Hospital-acquired infection following spinal tumor surgery: A frailty-driven pre-operative risk model

Cited by 4 publications

References 35 publications

Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic

Multiplicative effect of frailty and obesity on postoperative mortality following spine surgery: a deep dive into the frailty, obesity, and Clavien-Dindo dynamic

Causes and Predictors of Unplanned Readmission in Patients Undergoing Intracranial Tumor Resection: A Multicenter Analysis of 31,776 Patients

Frailty Predicts 30-day Mortality in Spine Surgery Patients Classified as Obese and the Risk Analysis Index Exhibits Excellent Discrimination

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