Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS).

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Purpose of Study
Study Review

Patients with spinal metastasis are associated with many medical comorbidities.  While surgical management for spine metastasis can improve quality of life, and improve function, The potential for complication, and worsening outcomes must be considered.

This paper reviewed patient data from participating centers from 2007 to 2013 And assessed the 30 day mortality and morbidity for surgical treatment of metastatic spinal conditions.

Because data was collected from the National Surgical Quality Improvement Program (NSQIP), postsurgical data collection was limited to the first 30 days.    Of the 1100 patients who underwent the surgical procedures, information that was collected and examined was completed in 776 patients.

Preoperatively, the so called New England Spine Metastasis Score  (NESMS) utilizing  serum albumin levels, ambulatory status,  and the modified Bauer’s Score of spinal metastasis was calculated.

Based on NSQIP data,  Postoperative mortality,  major morbidity,  Failure to Rescue, Length of hospital Stay,  readmission and  reoperation within the first 30 days was collected on these 776 patients.

In the final analysis,  the NESMS score Became a statistical predictor of mortality,Major systemic complications, and failure to rescue status within the first 30 days of spinal metastatic disease surgery.

The best clinical NESMS score indicates a normal ambulatory status, a pre-op serum albumin equal or greater  than 3.5 g/dL, and a Modified Bauer Score of equal or greater than 3.   This would equal a NESMS score of 3.

Those patients with a score of 3 has significant reduced rates of mortality, major complications, and failure to rescue in the NSQIP data set.

The authors do acknowledge some shortcomings of the study.  The NSQIP tracks only the initial 30 days after surgery.  Some of the data about the types of malignancy may change the Bauer scores.

Nevertheless, the information confirms clinical suspicion that patient’s with specific types of malignancy, low albumin, and poor ambulatory status have higher rates of mortality and complications.



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