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>
Post-operative hyperglycemia and its association with surgical site infection after instrumented spinal fusion.
Spine surgery; Hyperglycemia; Spinal fusion; serum glucose; Surgical site infection
OBJECTIVE: To evaluate the correlation between postoperative hyperglycemia and surgical site infection among patients who underwent primary instrumented spinal fusion surgery. PATIENTS AND METHODS: We collected data on all eligible patients treated at our institution over the course of 2005-2017. We defined serum hyperglycemia using a primary threshold of serum glucose ≥140 mg/dL and used ≥115 mg/dL as a secondary test. We used logistic regression techniques to evaluate unadjusted results for serum hyperglycemia on revision surgeries for infection, followed by sequential adjustment for sociodemographic and procedural characteristics. RESULTS: We included 3664 patients. Surgical site infections occurred in 4%. Post-operative hyperglycemia was significantly associated with a higher rate of revision surgery for infection (p = 0.02). Following adjusted analysis, hyperglycemia remained a statistically significant predictor for revision surgery due to infection (OR 2.19; 95 % CI 1.13, 4.25). Similar results were evident when using the lower threshold of ≥115 mg/dL (OR 2.36; 95 % CI 1.06, 5.23). CONCLUSIONS: This study highlights the importance of measuring serum glucose after spinal fusion and the need for heightened surveillance and/or treatment in those who exhibit postoperative hyperglycemia. In this context, it could be advantageous to use a lower threshold for hyperglycemia (115 mg/dL) in order to trigger interventions for glycemic control.
Upadhyaya S; Lopez WY; Goh BC; Chen AF; Blucher JA; Beck A; Kang JD; Schoenfeld AJ
Clinical Neurology and Neurosurgery
2020
2020-07-20
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.clineuro.2020.106100" target="_blank" rel="noreferrer noopener">10.1016/j.clineuro.2020.106100</a>