title: Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Length of Stay After Spine Surgery.
abstract: OBJECTIVE
  The aim of this study was to develop a perioperative metastatic spinal tumor frailty index (MSTFI) that could predict morbidity, mortality, and length of stay.
  
  
  METHODS
  A large inpatient hospitalization database was searched from 2002 to 2011 to identify 4583 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 9 independent parameters that were used to construct the MSTFI: anemia, chronic lung disease, coagulopathy, electrolyte abnormalities, pulmonary circulation disorders, renal failure, malnutrition, emergent/urgent admission, and anterior/combined surgical approach. Patients with 0 points 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 with patients with no frailty, patients with moderate frailty (odds ratio [OR] 5.15; 95% confidence interval [95% CI] 2.44-10.86), and severe frailty (OR 5.74; 95% CI 2.69-12.24) had significantly increased odds of inpatient mortality (all P < 0.001). Similarly, patients with mild frailty (OR 1.88; 95% CI 1.33-2.66), moderate frailty (OR 3.83; 95% CI 2.71-5.41), and severe frailty (OR 6.97; 95% CI 4.98-9.74) had significantly increased odds of developing a major in-hospital complication (all P < 0.001). Length of stay also increased significantly by MSTFI (P < 0.001).
  
  
  CONCLUSIONS
  In surgically treated patients with spinal metastasis, certain perioperative parameters may significantly predict the risk of major in-hospital complications and mortality.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza Ramos
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Abu-Bonsrah
authors.affiliation: Divison of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000740:Anemia / Q000453:epidemiology; D001778:Blood Coagulation Disorders / Q000453:epidemiology; D001943:Breast Neoplasms / Q000473:pathology; D002908:Chronic Disease; D016208:Databases, Factual; D004630:Emergencies; D005260:Female; D016330:Frail Elderly; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008171:Lung Diseases / Q000453:epidemiology; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D016017:Odds Ratio; D010998:Pleurisy / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011030:Pneumothorax / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000473:pathology; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000473:pathology; D014481:United States / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology
keywords: Cancer; Frailty; Frailty index; Metastasis; Spinal metastatic tumor; Spine surgery