Prediction of Discharge Status and Readmissions after Resection of Intradural Spinal Tumors

• Published in: Neurospine Vol. 19; no. 1; pp. 133 - 145
• Main Authors: Jin, Michael C., Ho, Allen L., Feng, Austin Y., Medress, Zachary A., Pendharkar, Arjun V., Rezaii, Paymon, Ratliff, John K., Desai, Atman M.
• Format: Journal Article
• Language: English
• Published: Korean Spinal Neurosurgery Society 01-03-2022; 대한척추신경외과학회
• Subjects: intradural spine tumor; machine learning; Original; predictive modeling; 신경외과학
• ISSN: 2586-6583; 2586-6591
• DOI: 10.14245/ns.2143244.622

Objective: Intradural spinal tumors are uncommon and while associations between clinical characteristics and surgical outcomes have been explored, there remains a paucity of literature unifying diverse predictors into an integrated risk model. To predict postresection outcomes for patients with spinal tumors.Methods: IBM MarketScan Claims Database was queried for adult patients receiving surgery for intradural tumors between 2007 and 2016. Primary outcomes-of-interest were nonhome discharge and 90-day postdischarge readmissions. Secondary outcomes included hospitalization duration and postoperative complications. Risk modeling was developed using a regularized logistic regression framework (LASSO, least absolute shrinkage and selection operator) and validated in a withheld subset.Results: A total of 5,060 adult patients were included. Most surgeries utilized a posterior approach (n = 5,023, 99.3%) and tumors were most commonly found in the thoracic region (n = 1,941, 38.4%), followed by the lumbar (n = 1,781, 35.2%) and cervical (n = 1,294, 25.6%) regions. Compared to models using only tumor-specific or patient-specific features, our integrated models demonstrated better discrimination (area under the curve [AUC] [nonhome discharge] = 0.786; AUC [90-day readmissions] = 0.693) and accuracy (Brier score [nonhome discharge] = 0.155; Brier score [90-day readmissions] = 0.093). Compared to those predicted to be lowest risk, patients predicted to be highest-risk for nonhome discharge required continued care 16.3 times more frequently (64.5% vs. 3.9%). Similarly, patients predicted to be at highest risk for postdischarge readmissions were readmitted 7.3 times as often as those predicted to be at lowest risk (32.6% vs. 4.4%).Conclusion: Using a diverse set of clinical characteristics spanning tumor-, patient-, and hospitalization-derived data, we developed and validated risk models integrating diverse clinical data for predicting nonhome discharge and postdischarge readmissions.