Highlights
- •A thoracic spinal stenosis surgical invasiveness index was developed and validated based on an analysis of 989 patients.
- •The novel index consisted of five specific predictors: Body mass index, posterior decompression, instrumentation, circumferential decompression, and concomitant dekyphosis.
- •The new index explained more variability in operative time and estimated blood loss than the previous index and might be a better one for predicting surgical invasiveness of thoracic spinal stenosis.
Abstract
Background context
Surgical invasiveness indices have been established for general spine surgery (surgical
invasiveness index [SII]), spine deformity, and metastatic spine tumors; however,
a specific index for thoracic spinal stenosis (TSS) has not been developed.
Purpose
To develop and validate a novel invasiveness index, incorporating TSS-specific factors
for open posterior TSS surgery, which may facilitate the prediction of operative duration
and intraoperative blood loss, and the stratification of surgical risk.
Study design
A retrospective observational study.
Patient sample
Overall, 989 patients who underwent open posterior TSS surgeries at our institution
during the past 5 years were included.
Outcome measures
The operation duration, estimated blood loss, transfusion status, major surgical complications,
length of hospital stay, and medical expenses.
Methods
We retrospectively analyzed the data of 989 consecutive patients who underwent posterior
surgery for TSS between March 2017 and February 2022. Among them, 70% (n=692) were
randomly placed in a training cohort, and the remaining 30% (n=297) automatically
constituted the validation cohort. Multivariate linear regression models of operative
time and log-transformed estimated blood loss were created using TSS-specific factors.
Beta coefficients derived from these models were used to construct a TSS invasiveness
index (TII). The ability of the TII to predict surgical invasiveness was compared
with that of the SII and assessed in a validation cohort.
Results
The TII was more strongly correlated with operative time and estimated blood loss
(p<.05) and explained more variability in operative time and estimated blood loss
than the SII (p<.05). The TII explained 64.2% of operative time and 34.6% of estimated
blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In
further verification, the TII was more strongly associated with transfusion rate,
drainage time, and length of hospital stay than SII (p<.05).
Conclusions
By incorporating TSS-specific components, the newly developed TII more accurately
predicts the invasiveness of open posterior TSS surgery than the previous index.
Keywords
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Article info
Publication history
Published online: April 24, 2023
Accepted:
April 18,
2023
Received in revised form:
March 7,
2023
Received:
November 28,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: YH: Nothing to disclose. JQ: Nothing to disclose. YD: Nothing to disclose. HZ: Nothing to disclose. QZ: Nothing to disclose. JB: Nothing to disclose. CW: Nothing to disclose. ZC: Nothing to disclose. WL: Nothing to disclose. YT: Nothing to disclose. CS: Nothing to disclose.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
