Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model
Objective The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for single-level lumbar decompression, and p...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Spinal Neurosurgery Society
2023-03-01
|
| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://e-neurospine.org/upload/pdf/ns-2346110-055.pdf |
| _version_ | 1797329548311789568 |
|---|---|
| author | Alexander J. Kassicieh Kavelin Rumalla Aaron C. Segura Syed Faraz Kazim John Vellek Meic H. Schmidt Peter C. Shin Christian A. Bowers |
| author_facet | Alexander J. Kassicieh Kavelin Rumalla Aaron C. Segura Syed Faraz Kazim John Vellek Meic H. Schmidt Peter C. Shin Christian A. Bowers |
| author_sort | Alexander J. Kassicieh |
| collection | DOAJ |
| description | Objective The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for single-level lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition. Methods Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017–2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver. Results Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65–0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73–0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85–0.88). Conclusion After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decision-making with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo. |
| first_indexed | 2024-03-08T07:07:08Z |
| format | Article |
| id | doaj.art-c50338afd1be4bb491823c236b967905 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T07:07:08Z |
| publishDate | 2023-03-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-c50338afd1be4bb491823c236b9679052024-02-03T04:29:36ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912023-03-0120111912810.14245/ns.2346110.0551387Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive ModelAlexander J. Kassicieh0Kavelin Rumalla1Aaron C. Segura2Syed Faraz Kazim3John Vellek4Meic H. Schmidt5Peter C. Shin6Christian A. Bowers7 Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USAObjective The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for single-level lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition. Methods Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017–2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver. Results Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65–0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73–0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85–0.88). Conclusion After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decision-making with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo.http://e-neurospine.org/upload/pdf/ns-2346110-055.pdfageendoscopic spine surgeryfrailtymodified frailty indexnational surgical quality improvement programrisk analysis index |
| spellingShingle | Alexander J. Kassicieh Kavelin Rumalla Aaron C. Segura Syed Faraz Kazim John Vellek Meic H. Schmidt Peter C. Shin Christian A. Bowers Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model Neurospine age endoscopic spine surgery frailty modified frailty index national surgical quality improvement program risk analysis index |
| title | Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model |
| title_full | Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model |
| title_fullStr | Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model |
| title_full_unstemmed | Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model |
| title_short | Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model |
| title_sort | endoscopic and nonendoscopic approaches to single level lumbar spine decompression propensity score matched comparative analysis and frailty driven predictive model |
| topic | age endoscopic spine surgery frailty modified frailty index national surgical quality improvement program risk analysis index |
| url | http://e-neurospine.org/upload/pdf/ns-2346110-055.pdf |
| work_keys_str_mv | AT alexanderjkassicieh endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel AT kavelinrumalla endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel AT aaroncsegura endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel AT syedfarazkazim endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel AT johnvellek endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel AT meichschmidt endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel AT petercshin endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel AT christianabowers endoscopicandnonendoscopicapproachestosinglelevellumbarspinedecompressionpropensityscorematchedcomparativeanalysisandfrailtydrivenpredictivemodel |