mFI-5 as a Predictor of Post-Surgical Adverse Events Following Extradural Tumor Excision in Patients with Metastatic Cancer Adam
1 Strigenz ,
Mitchell Lee-Seitz 1Donald
Background Spinal Tumors: Determining how to manage spinal tumors presents a number of unique challenges. Palliation, prolonged survival, and curative treatment, while all different, are of the several possible outcomes following surgical resection (1). Intervention: Surgical intervention is complex and with meaningful risk of adverse events (2). Frailty: Frailty has been an increasingly studied variable for preoperative risk stratification. However, its value in surgical management of metastatic disease is unclear. Goal: We seek to evaluate the utility of the 5-item modified Frailty Index (mFI-5) in predicting adverse events (30-day readmission, reoperation, and morbidity) following extradural tumor resection, hereby providing another tool to better determine risk prior to surgery.
Hypothesis Hypothesis: We predict that more frail groups, as determined by their mFI-5 scores (mFI-5 = 0, non-frail; mFI-5 = 1-2, frail; mFI-5 = 3-5, severely frail), will be significantly associated with 30-day adverse outcomes following extradural tumor excision as compared to less the frail groups.
1 Jr. ,
David Essig
1 MD ,
Austen Katz
1 MD
and Barbara Zucker School of Medicine at Hofstra/Northwell
Methods
Results/Conclusions
Data Extraction: The National Surgical Quality Improvement Program was queried for patients undergoing extradural tumor resection. Inclusion/Exclusion: Included in our dataset was all patients with removal of an extradural tumor (n = 3744). Important exclusion criteria included: patients without instrumentation codes, patients with missing readmission data, and patients without metastatic cancer to the spine (now, n = 882).
Statistical Analysis: A Pearson chi-square test will be used to calculate rates of adverse outcomes between frailty groups. Further, univariate and multivariate logistic regression will be used to determine unadjusted and adjusted odds ratios. Confounders: Significant confounding variables will be controlled for to ensure a direct association between mFI-5 and adverse outcomes -- these include: age, BMI, OR time, ASA score, etc. Age, mean (Std. Deviation) Sex (female), number (%) BMI, mean (Std. Deviation) Non-Frail (mFI = 0), number (%) Frail (mFI = 1), number (%) Severely Frail (mFI = 2-5), number (%) * Dependent Health Status, number (%) Figure 7: Independent CRISPR knockout of CDK4 or CDK6 * Diabetes Mellitus number (%) does not cause dropout in most breast with cancer cellInsulin, lines studied. * HTN. Requiring Medication, number (%) * History of Severe COPD, number (%) *CHF in 30 Days Before Surgery, number (%)
61 (12) 343 (38.9%) 27.6 (5.7) 396 (44.9%) 331 (37.5%) 155 (17.6%) 79 (9.0%) 110 (12.5%) 416 (47.2%) 48 (5.4%) 7 (0.8%)
Figure 1: Pertinent descriptive statistics. * indicates variable included in the mFI-5 index.
Literature Review
We conducted a comprehensive/focused literature review of papers that analyze the mFI-5 index as a predictor of postoperative risk in spinal surgeries and in extradural tumor excision (n = 23).
Dataset
We applied appropriate exclusions, coded string variables to binary, cleaned the dataset of missing data, and made three frailty groups dummy coded to a binary variable.
Statistics
We ran descriptive statistics on variables to be included (Figure 1).
Future Direction Future Direction: We intend to conduct the statistical analyses necessary -- and interpret the results -- to prove/disprove the mFI-5 as an effective predictor of morbidity, mortality, and readmission. Further, we intend to turn this project into a manuscript and submit for publication.
Resources • Dr. David Essig, MD & Dr. Austen Katz, MD (PGY-3) Citations: 1.Hsu W, Kosztowski TA, Zaidi HA, et al. Multidisciplinary management of primary tumors of the vertebral column. Curr Treat Options Oncol 2009; 10:107–125. 2.Karhade AV, Vasudeva VS, Dasenbrock HH, et al. Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis. Neurosurg Focus 2016; 41:E5.