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Purpose <p>This study evaluates the combined effects of frailty, anemia, and malnutrition on outcomes in spinal metastases patients.</p> Methods <p>We conducted a retrospective cohort study using the 2011–2022 NSQIP database. Adult patients undergoing spinal surgery for spinal metastases were identified using CPT and ICD codes and stratified based on Risk Analysis Index-revised (RAI-rev) frailty status; frail patients were subdivided based on anemia and malnutrition status. Our primary outcomes were extended hospital length of stay (LOS), 30-day adverse events (AEs), non-routine discharge (NRD), and 30-day mortality. For each outcome, we fitted four nested multivariable logistic regression models (RAI-rev + anemia + malnutrition, RAI-rev + anemia, RAI-rev + malnutrition, and RAI-rev alone) and compared the incremental discrimination of each model using receiver operating characteristic (ROC) analysis.</p> Results <p>1530 patients were stratified accordingly: 355 Frail Alone, 540 Frail + Anemic, 85 Frail + Malnourished, 407 Frail + Anemic + Malnourished, and 143 Not Frail. RAI-rev and malnourishment were risk factors for extended LOS ((RAI-rev:&#xa0;<i>aOR 1.04, 95% CI 1.01–1.08</i>; malnourishment:&#xa0;<i>aOR 1.98, 95% CI 1.44–2.73</i>)<Emphasis Type="Underline">)</Emphasis> and mortality (RAI-rev:&#xa0;<i>aOR: 1.07, 95% CI 1.03–1.11</i>; malnourishment:&#xa0;<i>aOR: 2.37, 95% CI 1.50–3.75</i><Emphasis Type="Underline">)</Emphasis>. RAI-rev (<i>aOR 1.02, 95% CI 1.00–1.03</i>) and anemia (<i>aOR 2.06, 95% CI 1.50–2.84</i>) independently predicted AEs and malnourishment predicted NRD (<i>aOR 1.56, 95% CI 1.15–2.13</i>). On ROC analysis, RAI-rev + anemic + malnourished superiorly predicted extended LOS (<Emphasis Type="ItalicUnderline">p</Emphasis><Emphasis Type="Underline"> = </Emphasis><Emphasis Type="ItalicUnderline">0.021</Emphasis>), AEs (<Emphasis Type="ItalicUnderline">p</Emphasis><Emphasis Type="Underline"> = </Emphasis><Emphasis Type="ItalicUnderline">0.035</Emphasis>), and mortality (<Emphasis Type="ItalicUnderline">p</Emphasis><Emphasis Type="Underline"> = </Emphasis><Emphasis Type="ItalicUnderline">0.023</Emphasis>) compared to RAI-rev. RAI-rev + malnourished outperformed RAI-rev in predicting extended LOS (<Emphasis Type="ItalicUnderline">p</Emphasis><Emphasis Type="Underline"> = </Emphasis><Emphasis Type="ItalicUnderline">0.035</Emphasis>) and mortality (<Emphasis Type="ItalicUnderline">p</Emphasis><Emphasis Type="Underline"> = </Emphasis><Emphasis Type="ItalicUnderline">0.020</Emphasis>). RAI-rev + anemic outperformed RAI-rev in predicting AEs (<Emphasis Type="ItalicUnderline">p</Emphasis><Emphasis Type="Underline"> = </Emphasis><Emphasis Type="ItalicUnderline">0.032</Emphasis>).</p> Conclusion <p>Our study suggests that RAI-rev-defined frailty combined with anemia and malnutrition is a superior predictor of outcomes in spinal metastases patients.</p>

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Assessing combined effects of risk analysis index-revised (RAI-rev), malnutrition, and anemia on morbidity and mortality after spine surgery for metastatic spinal tumors

  • 期刊论文

  • 发表日期：

    2025年5月22日

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  • Aladine A. Elsamadicy,
  • Paul Serrato,
  • Shaila D. Ghanekar,
  • Ethan D. L. Brown,
  • Max Ward,
  • Zach Pennington,
  • Daniel Schneider,
  • Sheng-fu Larry Lo,
  • Daniel M. Sciubba

摘要

Purpose

This study evaluates the combined effects of frailty, anemia, and malnutrition on outcomes in spinal metastases patients.

Methods

We conducted a retrospective cohort study using the 2011–2022 NSQIP database. Adult patients undergoing spinal surgery for spinal metastases were identified using CPT and ICD codes and stratified based on Risk Analysis Index-revised (RAI-rev) frailty status; frail patients were subdivided based on anemia and malnutrition status. Our primary outcomes were extended hospital length of stay (LOS), 30-day adverse events (AEs), non-routine discharge (NRD), and 30-day mortality. For each outcome, we fitted four nested multivariable logistic regression models (RAI-rev + anemia + malnutrition, RAI-rev + anemia, RAI-rev + malnutrition, and RAI-rev alone) and compared the incremental discrimination of each model using receiver operating characteristic (ROC) analysis.

Results

1530 patients were stratified accordingly: 355 Frail Alone, 540 Frail + Anemic, 85 Frail + Malnourished, 407 Frail + Anemic + Malnourished, and 143 Not Frail. RAI-rev and malnourishment were risk factors for extended LOS ((RAI-rev: aOR 1.04, 95% CI 1.01–1.08; malnourishment: aOR 1.98, 95% CI 1.44–2.73)) and mortality (RAI-rev: aOR: 1.07, 95% CI 1.03–1.11; malnourishment: aOR: 2.37, 95% CI 1.50–3.75). RAI-rev (aOR 1.02, 95% CI 1.00–1.03) and anemia (aOR 2.06, 95% CI 1.50–2.84) independently predicted AEs and malnourishment predicted NRD (aOR 1.56, 95% CI 1.15–2.13). On ROC analysis, RAI-rev + anemic + malnourished superiorly predicted extended LOS (p = 0.021), AEs (p = 0.035), and mortality (p = 0.023) compared to RAI-rev. RAI-rev + malnourished outperformed RAI-rev in predicting extended LOS (p = 0.035) and mortality (p = 0.020). RAI-rev + anemic outperformed RAI-rev in predicting AEs (p = 0.032).

Conclusion

Our study suggests that RAI-rev-defined frailty combined with anemia and malnutrition is a superior predictor of outcomes in spinal metastases patients.