Spine J. 2023 Apr 24:S1529-9430(23)00171-7. doi: 10.1016/j.spinee.2023.04.013. Online ahead of print.
ABSTRACT
BACKGROUND CONTEXT: Surgical invasiveness indices have been established for general spine surgery (surgical invasiveness index [SII]), spine deformity, and metastatic spine tumors; however, a specific index for thoracic spinal stenosis (TSS) has not been developed.
PURPOSE: To develop and validate a novel invasiveness index incorporating TSS-specific factors for open posterior TSS surgery, which may facilitate the prediction of operative duration and intraoperative blood loss, and the stratification of surgical risk.
STUDY DESIGN: A retrospective observational study.
PATIENT SAMPLE: Overall, 989 patients who underwent open posterior TSS surgeries at our institution during the past 5 years were included.
OUTCOME MEASURES: The operation duration, estimated blood loss, transfusion status, major surgical complications, length of hospital stay, and medical expenses.
METHODS: We retrospectively analyzed the data of 989 consecutive patients who underwent posterior surgery for TSS between March 2017 and February 2022. Among them, 70% (n = 692) were randomly placed in a training cohort, and the remaining 30% (n = 297) automatically constituted the validation cohort. Multivariate linear regression models of operative time and log-transformed estimated blood loss were created using TSS-specific factors. Beta coefficients derived from these models were used to construct a TSS invasiveness index (TII). The ability of the TII to predict surgical invasiveness was compared with that of the SII and assessed in a validation cohort.
RESULTS: The TII was more strongly correlated with operative time and estimated blood loss (P < 0.05) and explained more variability in operative time and estimated blood loss than the SII (P < 0.05). The TII explained 64.2% of operative time and 34.6% of estimated blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In further verification, the TII was more strongly associated with transfusion rate, drainage time, and length of hospital stay than SII (P < 0.05).
CONCLUSION: By incorporating TSS-specific components, the newly developed TII more accurately predicts the invasiveness of open posterior TSS surgery than the previous index.
PMID:37100245 | DOI:10.1016/j.spinee.2023.04.013
