Frailty has been gathering attention as a factor to predict surgical outcomes. However, the association of frailty with postoperative complications remains controversial in spinal metastases surgery. We therefore designed a prospective study to elucidate risk factors for postoperative complications with a focus on frailty. We prospectively analyzed 241 patients with spinal metastasis who underwent palliative surgery from June 2015 to December 2021. Postoperative complications were assessed by the Clavien-Dindo classification; scores of ≥ Grade II were defined as complications. Data were collected regarding demographics (age, sex, BMI, and primary cancer) and preoperative clinical factors (new Katagiri score, Frankel grade, performance status, radiotherapy, chemotherapy, spinal instability neoplastic score, modified Frailty Index-11 (mFI), diabetes, and serum albumin levels). Univariate and multivariate analyses were developed to identify risk factors for postoperative complications (p < 0.05).Aims
Methods
The revised Tokuhashi, Tomita and modified Bauer
scores are commonly used to make difficult decisions in the management
of patients presenting with spinal metastases. A prospective cohort
study of 199 consecutive patients presenting with spinal metastases,
treated with either surgery and/or radiotherapy, was used to compare
the three systems. Cox regression, Nagelkerke’s R2 and
Harrell’s concordance were used to compare the systems and find their
best predictive items. The three systems were equally good in terms
of overall prognostic performance. Their most predictive items were
used to develop the Oswestry Spinal Risk Index (OSRI), which has
a similar concordance, but a larger coefficient of determination
than any of these three scores. A bootstrap procedure was used to
internally validate this score and determine its prediction optimism. The OSRI is a simple summation of two elements: primary tumour
pathology (PTP) and general condition (GC): OSRI = PTP + (2 – GC). This simple score can predict life expectancy accurately in patients
presenting with spinal metastases. It will be helpful in making
difficult clinical decisions without the delay of extensive investigations. Cite this article:
