Abstract
Background Context
The New England Spinal Metastasis Score (NESMS) was recently proposed to help predict
1-year survival following surgery for spinal metastases. Its ability to predict short-term
outcomes, including 30-day morbidity, mortality, and hospital length of stay, has
not been evaluated.
Purpose
Assess the capacity of NESMS to predict 30-day morbidity and mortality, as well as
hospital length of stay, following surgery for spinal metastases.
Study Design
Validation study.
Patient Sample
All patients who had undergone spinal surgery with a history of metastatic spinal
disease within the National Surgical Quality Improvement Program (NSQIP; 2007–2013).
Outcome Measure
Mortality, complications, failure to rescue, and length of stay.
Methods
Demographic, oncologic, laboratory, and surgical data were obtained from the NSQIP.
All patients were assigned an NESMS score (0–3). The effect of the NESMS score on
the outcomes of interest was assessed using multivariable logistic regression and
negative binomial regression that controlled for confounders. Final model discrimination
and calibration were assessed using the c-statistic and Hosmer-Lemeshow test, respectively.
Internal validation was performed using a bootstrapping procedure.
Results
NSQIP data on 776 patients were included in this analysis. The 30-day mortality rate
was 11% (N=87), and 51% of patients (N=395) sustained one or more complications. The
final adjusted model demonstrated that the NESMS was a statistically significant predictor
of 30-day mortality (p<.001), major systemic complications (p<.001), and failure to
rescue (p=.03) following metastatic spinal surgery. Patients with an NESMS score of
3 had an 89% reduction in mortality (95% confidence interval [CI]: 0.04, 0.31), a
74% reduction in major systemic complications (95% CI: 0.11, 0.62), and an 88% reduction
in failure to rescue (95% CI: 0.03, 0.47) as compared with those with a score of 0.
The final model explained 71% of the variation in 30-day mortality. Findings were
unchanged in the bootstrap analysis performed among 77,600 patient replicates.
Conclusion
This study demonstrates the clinical accuracy of the NESMS score for predicting short-term
major morbidity and mortality following metastatic spinal surgery. The success of
this score in an independent cohort of patients collected from centers across the
United States indicates its potential for translation to clinical practice.
Keywords
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Article info
Publication history
Published online: September 24, 2015
Accepted:
September 21,
2015
Received in revised form:
September 21,
2015
Received:
July 15,
2015
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: AJS: Grant: Robert Wood Johnson Foundation (F, Paid directly to institution); Personal fees: ArborMetrix (B); Other: Wolters Kluwers (A, Royalties, outside the submitted work), The Spine Journal (Nonfinancial, Deputy Editor), NASS (Nonfinancial, CME Committee), Journal of Orthopaedic Trauma (Section Editor, Health Reform). HVL: Nothing to disclose. YM: Nothing to disclose. DAL: Nothing to disclose. PJB: Royalties: Slack Incorporated (B, Paid directly to institution, outside the submitted work). CMB: Personal fees: United Health Care (B, Advisory Board), CRICO (B, Expert Testimony), Wolters Kluwers (B, Royalties), Journal of the American Academy of Orthopaedic Surgeons (B, Deputy Editor Stipend), NASS (Nonfinancial, Board Member). MBH: NASS (Nonfinancial, Board Member).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Disclaimers: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the hospitals participating in the ACS NSQIP are the source of the data used herein. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Level of Evidence: II.
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.
