Prospective comparison of the accuracy of the New England spinal metastasis score (NESMS) to legacy scoring systems in prognosticating outcomes following treatment of spinal metastases.
Decision-making; NESMS; Prognostic score; SINS; Spinal metastases; Survival; Tokuhashi; Tomita
BACKGROUND CONTEXT: We developed the New England Spinal Metastasis Score (NESMS) as a simple, informative, scoring scheme that could be applied to both operative and non-operative patients. The performance of the NESMS to other legacy scoring systems has not previously been compared using appropriately powered, prospectively collected, longitudinal data. PURPOSE: To compare the predictive capacity of the NESMS to the Tokuhashi, Tomita and Spinal Instability Neoplastic Score (SINS) in a prospective cohort, where all scores were assigned at the time of baseline enrollment. PATIENT SAMPLE: We enrolled 202 patients with spinal metastases who met inclusion criteria between 2017-2019. OUTCOME MEASURES: One-year survival (primary); 3-month mortality and ambulatory function at 3- and 6-months were considered secondarily. METHODS: All prognostic scores were assigned based on enrollment data, which was also assigned as time-zero. Patients were followed until death or survival at 365 days after enrollment. Survival was assessed using Kaplan-Meier curves and score performance was determined via logistic regression testing and observed to expected plots. The discriminative capacity (c-statistic) of the scoring measures were compared via the z-score. RESULTS: When comparing the discriminative capacity of the predictive scores, the NESMS had the highest c-statistic (0.79), followed by the Tomita (0.69), the Tokuhashi (0.67) and the SINS (0.54). The discriminative capacity of the NESMS was significantly greater (p-value range: 0.02 to <0.001) than any of the other predictive tools. The NESMS was also able to inform independent ambulatory function at 3- and 6-months, a function that was only uniformly replicated by the Tokuhashi score. CONCLUSIONS: The results of this prospective validation study indicate that the NESMS was able to differentiate survival to a significantly higher degree than the Tokuhashi, Tomita and SINS. We believe that these findings endorse the utilization of the NESMS as a prognostic tool capable of informing care for patients with spinal metastases.
Schoenfeld AJ; Ferrone ML; Blucher JA; Agaronnik N; Nguyen L; Tobert Daniel G; Balboni TA; Schwab JH; Shin JH; Sciubba DM; Harris MB
The Spine Journal
2021
2021-03-16
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.spinee.2021.03.007" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2021.03.007</a>
Prospective validation of a clinical prediction score for survival in patients with spinal metastases: the New England Spinal Metastasis Score.
Surgery; Survival; Decision-making; NESMS; Spinal metastases; Predictive score
BACKGROUND CONTEXT: The New England Spinal Metastasis Score (NESMS) was proposed as an intuitive and accessible prognostic tool for predicting survival in patients with spinal metastases. We designed an appropriately powered, prospective, longitudinal investigation to validate the NESMS. PURPOSE: To prospectively validate the NESMS. STUDY DESIGN: Prospective longitudinal observational cohort study. PATIENT SAMPLE: Patients, aged 18 and older, presenting for treatment with spinal metastatic disease. OUTCOME MEASURES: One-year mortality (primary); 6-month mortality and mortality at any time point following enrollment (secondary). METHODS: The date of enrollment was set as time zero for all patients. The NESMS was assigned based on data collected at the time of enrollment. Patients were prospectively followed to one of two predetermined end-points: death, or survival at 365 days following enrollment. Survival was visually assessed with Kaplan-Meier curves and then analyzed using multivariable logistic regression, followed by Bayesian regression to assess for robustness of point estimates and 95% confidence intervals (CI). RESULTS: This study included 180 patients enrolled between 2017 and 2018. Mortality within 1-year occurred in 56% of the cohort. Using NESMS 3 as the referent, those with a score of 2 had significantly greater odds of mortality (odds ratio 7.04; 95% CI 2.47, 20.08), as did those with a score of 1 (odds ratio 31.30; 95% CI 8.82, 111.04). A NESMS score of 0 was associated with perfect prediction, as 100% of individuals with this score were deceased at 1-year. Similar determinations were encountered for mortality at 6-months and overall. CONCLUSIONS: This study validates the NESMS and demonstrates its utility in prognosticating survival for patients with spinal metastatic disease, irrespective of selected treatment strategy. This is the first study to prospectively validate a prognostic utility for patients with spinal metastases. The NESMS can be directly applied to patient care, hospital-based practice and health-care policy.
Schoenfeld AJ;Ferrone ML;Schwab JH;Blucher JA;Barton LB;Tobert DG;Chi JH;Shin JH;Kang JD;Harris MB
The Spine Journal
2021
2021-01
journalArticle
<a href="http://doi.org/10.1016/j.spinee.2020.02.009" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2020.02.009</a>
Comparison of the stopping opioids after surgery (SOS) score to preoperative morphine milligram equivalents (MME) for prediction of opioid prescribing after lumbar spine surgery.
lumbar spine surgery; morphine milliequivalents; opioid dependence; prescription opioid use; risk score; Stopping Opioids after Surgery (SOS) score
BACKGROUND CONTEXT: Reliable estimation of the likelihood for prolonged postoperative opioid use may aid targeted interventions for high-risk patients. Previous studies have recommended differing methodologies for prediction of sustained postoperative opioid use. PURPOSE: To compare the performance of the Stopping Opioids after Surgery (SOS) score and preoperative morphine milligram equivalents (MME) for postoperative opioid prescription exposure in a contemporary cohort of lumbar surgery patients. PATIENT SAMPLE: Adult patients undergoing posterior decompression with or without fusion for degenerative lumbar conditions between January 31(st), 2016 and May 31(st), 2019. STUDY DESIGN/SETTING: Retrospective review at two academic medical centers and three community hospitals. OUTCOME MEASURES: The primary outcome was sustained postoperative prescription opioid exposure at 3-months and 6-months. Reoperations and readmissions were considered secondarily. METHODS: SOS score and MME were assigned to patients based on data from their pre-operative surgical evaluation. Performance for both measures was assessed for all outcomes by discrimination, including c-statistic and receiver-operating curve analysis. Calibration of the low, medium and high-risk strata with the observed rates of postoperative adverse events were examined. RESULTS: Overall, 4165 patients were included in this study. Pre-operative prevalence of prescription opioid use was 31%. Rates of postoperative opioid prescriptions at 3-months and 6-months, were 3.3% (n = 136) and 1.5% (n = 61). The c-statistics of preoperative oral MME and SOS score for 3-month sustained opioid prescriptions were 0.64 and 0.78, respectively. The c-statistics of preoperative oral MME and SOS score for 6-month sustained opioid prescriptions were 0.64 and 0.82, respectively. C-statistics of preoperative oral MME and SOS score were much lower for reoperation and readmission, although SOS score outperformed MME for both outcomes. CONCLUSION: The SOS score clinically outperformed oral MME as a predictive measure for outcomes following lumbar spine surgery. The SOS score may be valuable for identifying individuals at high-risk for sustained prescription opioid use and associated adverse events following spine surgery.
Karhade AV; Schwab JH; Harris MB; Schoenfeld AJ
The Spine Journal
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.spinee.2020.06.005" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2020.06.005</a>