Neurosurgery Resident Case Western/University Hospitals Cleveland Medical Center Cleveland, Ohio, United States
Introduction: Patients with thoracic metastatic epidural spinal cord compression (MESCC) often undergo extensive surgical decompression to avoid functional decline. Scales including the Revised Cardiac Risk Index (RCRI) are used for surgical risk stratification in predicting perioperative morbidity, though this evaluation is limited in scope. The 5-item Modified Frailty Index (mFI-5) has been used as a predictor in degenerative spine surgery, and this study therefore applies the utility of the mFI-5 as a predictor of outcomes following transpedicular decompression/fusion for high-grade MESCC.
Methods: A retrospective chart review was conducted on patients who underwent transpedicular decompression and fusion for MESCC including baseline demographics, SINS score, pre- and postoperative Bilsky score, primary cancer type and RCRI. Exclusion criteria included decompression without instrumentation, involvement of cervical spine, prior spine surgery. Univariate analysis via simple logistic or linear regression was completed. Primary outcomes included length of stay (LOS), intraoperative estimated blood loss (EBL), readmission/reoperations within 90 days of index surgery, 90-day mortality, and post-hospitalization disposition.
Results: 127 patients were included. All patients underwent instrumentation with transpedicular decompression at the level of epidural compression. 90% of patients’ lesions were Bilsky 2 or greater. An increasing frailty was found to be a significant predictor of increased LOS (p < 0.01) and 90-day mortality (p < 0.05), despite RCRI and age not predicting these outcomes. Multivariate analysis adjusting for sex, BMI, and age still showed statistical significance (p < 0.05; p< 0.05, respectively). MFI-5 was not a significant predictor of reoperation or readmission within 90 days, or EBL. Age, and not mFI-5 or RCRI, was a significant predictor for posthospitalization non-home disposition (p=0.001).
Conclusion : mFI-5 has a larger effect size than age and RCRI in predicting LOS and 90-day mortality. Age, in congruence with prior studies, is a significant predictor for disposition to non-home facilities posthospitalization.
