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Musharbash FN, Khalifeh JM, Raad M, Puvanesarajah V, Lee SH, Neuman BJ, Kebaish KM. Predicting 30-day mortality after surgery for metastatic disease of the spine: the H 2-FAILS score. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2513-2520. [PMID: 37186159 DOI: 10.1007/s00586-023-07713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/14/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Scoring systems for metastatic spine disease focus on predicting long- to medium-term mortality or a combination of perioperative morbidity and mortality. However, accurate prediction of perioperative mortality alone may be the most important factor when considering surgical intervention. We aimed to develop and evaluate a new tool, the H2-FAILS score, to predict 30-day mortality after surgery for metastatic spine disease. METHODS Using the National Surgical Quality Improvement Program database, we identified 1195 adults who underwent surgery for metastatic spine disease from 2010 to 2018. Incidence of 30-day mortality was 8.7% (n = 104). Independent predictors of 30-day mortality were used to derive the H2-FAILS score. H2-FAILS is an acronym for: Heart failure (2 points), Functional dependence, Albumin deficiency, International normalized ratio elevation, Leukocytosis, and Smoking (1 point each). Discrimination was assessed using area under the receiver operating characteristic curve (AUC). The H2-FAILS score was compared with the American Society of Anesthesiologists Physical Status Classification (ASA Class), the 5-item modified Frailty Index (mFI-5), and the New England Spinal Metastasis Score (NESMS). Internal validation was performed using bootstrapping. Alpha = 0.05. RESULTS Predicted 30-day mortality was 1.8% for an H2-FAILS score of 0 and 78% for a score of 6. AUC of the H2-FAILS was 0.77 (95% confidence interval: 0.72-0.81), which was higher than the mFI-5 (AUC 0.58, p < 0.001), ASA Class (AUC 0.63, p < 0.001), and NESMS (AUC 0.70, p = 0.004). Internal validation showed an optimism-corrected AUC of 0.76. CONCLUSIONS The H2-FAILS score accurately predicts 30-day mortality after surgery for spinal metastasis. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Farah N Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jawad M Khalifeh
- Department of Neurosurgery, The Johns Hopkins University, 601 North Caroline Street, Suite 5223, Baltimore, MD, 21287, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sang H Lee
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Hu Y, Ouyang H, Ye K, Dong Y, Zhang X, Dong S, Chen Z, Liu Z, Liu X, Zeng Y, Wei F, Sun C, Tian Y, Li W. Thirty-day unplanned reoperations of thoracic spine surgery: 10 years of data from a single center with 3,242 patients. Spine J 2023; 23:703-714. [PMID: 36641036 DOI: 10.1016/j.spinee.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/25/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND CONTEXT Unplanned reoperation is a useful quality indicator for spine surgery. However, the rates of a 30-day unplanned reoperation in patients undergoing thoracic spinal surgery are not well established. PURPOSE To assess the rates, reasons, and risk factors of 30-day unplanned reoperations for thoracic spine surgeries in a single center study. STUDY DESIGN A retrospective observational study. PATIENT SAMPLE 3,242 patients who underwent thoracic spinal surgery at our institution in the past decade were included. OUTCOME MEASURES The incidence, chief reasons, and risk factors for unplanned reoperations within 30 days after thoracic spinal surgery. METHODS We retrospectively analyzed the data of all patients who underwent thoracic spinal surgery between January 2012 and December 2021. Statistical methods, including univariate and multivariate analyses, were performed to assess the incidence, reasons, and risk factors for thoracic degenerative diseases, spinal tumors, kyphosis deformity, and spinal trauma. RESULTS Of the 3,242 patients who underwent thoracic spinal surgery, 107 (3.30%) required unplanned reoperations within 30 days due to epidural hematoma (1.17%), wound complications (0.80%), implant complications (0.43%), inadequate decompression (0.25%), and other causes (0.65%). Patients with degenerative disease (3.88%), spinal tumor (2.98%), and kyphosis deformity (3.33%) had significantly higher incidences of reoperation than those with spinal trauma (1.47%). Unplanned reoperations were classified as hyperacute (30.84%), acute (31.76%), and subacute (37.38%). After univariate analysis, several factors were associated with unplanned reoperation in the 4 cohorts of thoracic spine diseases (p<.05). Multivariate logistic regression analysis revealed that upper thoracic spine surgery (p=.001), concomitant dekyphosis (p=.027), and longer activated partial thromboplastin time (p=.025) were risk factors of unplanned reoperation for thoracic degenerative disease. Whereas American Society of Anesthesiologists (ASA) grade III (p=.015), combined approach (p=.016), and operation time longer than 420 min (p=.042) for spinal tumor, and similar ankylosing spondylitis (p=.023) and operation time longer than 340 min (p=.041) were risk factors of unplanned reoperation for kyphosis deformity. CONCLUSIONS The unplanned reoperation rate for thoracic spine surgery was 3.30%, with epidural hematoma and wound complications being the most common reasons. However, upper thoracic spine surgery, concomitant dekyphosis, underlying coagulation disorder, longer operation time, higher ASA grade, and comorbidities of ankylosing spondylitis led to an increased risk of unplanned reoperation within 30 days of thoracic spine surgery.
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Affiliation(s)
- Yuanyu Hu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Kaifeng Ye
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Yanlei Dong
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Xin Zhang
- Information Management and Big Data Center, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Shu Dong
- Department of Medical Affairs, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Chuiguo Sun
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China.
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Road, Haidian District, 100191, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Road, Haidian District, 100191, Beijing , China.
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Li Z, Huang L, Guo B, Zhang P, Wang J, Wang X, Yao W. The predictive ability of routinely collected laboratory markers for surgically treated spinal metastases: a retrospective single institution study. BMC Cancer 2022; 22:1231. [PMID: 36447178 PMCID: PMC9706860 DOI: 10.1186/s12885-022-10334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to identify effective routinely collected laboratory biomarkers for predicting postoperative outcomes in surgically treated spinal metastases and attempted to establish an effective prediction model. METHODS This study included 268 patients with spinal metastases surgically treated at a single institution. We evaluated patient laboratory biomarkers to determine trends to predict survival. The markers included white blood cell (WBC) count, platelet count, neutrophil count, lymphocyte count, hemoglobin, albumin, alkaline phosphatase, creatinine, total bilirubin, calcium, international normalized ratio (INR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR). A nomogram based on laboratory markers was established to predict postoperative 90-day and 1-year survival. The discrimination and calibration were validated using concordance index (C-index), area under curves (AUC) from receiver operating characteristic curves, and calibration curves. Another 47 patients were used as a validation group to test the accuracy of the nomogram. The prediction accuracy of the nomogram was compared to Tomita, revised Tokuhashi, modified Bauer, and Skeletal Oncology Research Group machine-learning (SORG ML). RESULTS WBC, lymphocyte count, albumin, and creatinine were shown to be the independent prognostic factors. The four predictive laboratory markers and primary tumor, were incorporated into the nomogram to predict the 90-day and 1-year survival probability. The nomogram performed good with a C-index of 0.706 (0.702-0.710). For predicting 90-day survival, the AUC in the training group and the validation group was 0.740 (0.660-0.819) and 0.795 (0.568-1.000), respectively. For predicting 1-year survival, the AUC in the training group and the validation group was 0.765 (0.709-0.822) and 0.712 (0.547-0.877), respectively. Our nomogram seems to have better predictive accuracy than Tomita, revised Tokuhashi, and modified Bauer, alongside comparable prediction ability to SORG ML. CONCLUSIONS Our study confirmed that routinely collected laboratory markers are closely associated with the prognosis of spinal metastases. A nomogram based on primary tumor, WBC, lymphocyte count, albumin, and creatinine, could accurately predict postoperative survival for patients with spinal metastases.
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Affiliation(s)
- Zhehuang Li
- grid.414008.90000 0004 1799 4638Department of Musculoskeletal Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 45000 Henan China
| | - Lingling Huang
- grid.414008.90000 0004 1799 4638Department of Musculoskeletal Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 45000 Henan China
| | - Bairu Guo
- grid.414008.90000 0004 1799 4638Department of Musculoskeletal Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 45000 Henan China
| | - Peng Zhang
- grid.414008.90000 0004 1799 4638Department of Musculoskeletal Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 45000 Henan China
| | - Jiaqiang Wang
- grid.414008.90000 0004 1799 4638Department of Musculoskeletal Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 45000 Henan China
| | - Xin Wang
- grid.414008.90000 0004 1799 4638Department of Musculoskeletal Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 45000 Henan China
| | - Weitao Yao
- grid.414008.90000 0004 1799 4638Department of Musculoskeletal Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 45000 Henan China
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Mo K, Ortiz-Babilonia C, Al Farii H, Raad M, Musharbash FN, Neuman BJ, Kebaish KM. Increased Severity of Anemia Is Associated with Postoperative Complications following a Adult Spinal Deformity Surgery. World Neurosurg 2022; 167:e541-e548. [PMID: 35977677 DOI: 10.1016/j.wneu.2022.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anemia is a modifiable risk factor for postoperative complications following surgery. This study aimed to determine the impact of preoperative anemia severity on 30-day postoperative complications following adult spinal deformity (ASD) surgery. METHODS Adults undergoing spinal fusion for ASD from 2012 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were substratified into 3 cohorts-non-anemia, mild anemia, and moderate-to-severe anemia-based on World Health Organization definitions. We assessed 30-day wound, cardiac, pulmonary, renal, and thromboembolic complications, as well as sepsis, mortality, postoperative transfusions, extended length of stay, and reoperation. Bivariate analyses and multivariable logistic regression were performed. RESULTS Of 2173 patients, 1694 (78%) had no anemia, 307 (14%) had mild anemia, and 172 (8%) had moderate or severe anemia. Following adjustments, patients with mild anemia were more likely to have postoperative blood transfusions (odds ratio [OR] 1.80, P < 0.001) and extended length of stay (OR 1.43, P < 0.001). Patients with moderate-to-severe anemia were at increased risk of organ space infection (OR 3.27, P = 0.028), death (OR 13.15, P = 0.001), postoperative blood transfusion (OR 2.81, P < 0.001), and extended length of stay (OR 3.02, P < 0.001). CONCLUSIONS We found a stepwise and approximately two-fold increase in the odds ratio of postoperative transfusion and length of stay with increasing severity of anemia. Moderate-to-severe anemia was associated with increased odds of death and organ space infection. Patients with moderate-to-severe anemia should be medically optimized before ASD surgery.
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Affiliation(s)
- Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carlos Ortiz-Babilonia
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Humaid Al Farii
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Farah N Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Gao ZY, Zhang T, Zhang H, Pang CG, Xia Q. Effectiveness of Preoperative Embolization in Patients with Spinal Metastases: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 152:e745-e757. [PMID: 34153484 DOI: 10.1016/j.wneu.2021.06.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Debate on the effectiveness of preoperative embolization for spinal metastatic lesions, especially for nonhypervascular tumors, has persisted. The present study aimed to identify the effectiveness of preoperative embolization in patients who had undergone surgery for spinal metastasis. METHODS Two of us (Z.T. and Z.H.) independently searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases to identify eligible clinical studies that had compared the outcomes of patients treated surgically for spinal metastatic disease with or without preoperative embolization. The primary outcomes included intraoperative blood loss, perioperative blood loss, and transfusion requirements. The secondary outcomes include the operative time, overall survival, and complication rates. Meta-analyses were performed for subgroups of hypervascular, nonhypervascular, and mixed tumors. A fixed effects model was applied when I2 was <50%, and a random effects model was applied when I2 was >50%. RESULTS A total of 12 studies (1 randomized controlled trial and 11 retrospective case-control studies), with 744 patients, were included. Significantly less intraoperative blood loss (mean difference [MD], -1171.49 mL; 95% confidence interval [CI], -2283.10 to -59.88; P = 0.039), fewer blood transfusions (MD, -3.13 U; 95% CI, -4.86 to -1.39; P < 0.001), and shorter operative times (MD, -33.91 minutes; 95% CI, -59.65 to -8.17; P = 0.010) were identified for the embolization group in the hypervascular subgroup. In the nonhypervascular and mixed tumor subgroups, no differences in effectiveness were identified in blood loss, transfusion requirement, or operative time when stratified by the use of embolization. The overall survival and complication rates were similar between the embolization and nonembolization groups in each subgroup. CONCLUSIONS The current data support the use of preoperative embolization for hypervascular metastatic tumors to the spine. However, little evidence is available to support the use of preoperative embolization for nonhypervascular metastatic tumors to the spine.
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Affiliation(s)
- Zhong-Yu Gao
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Tao Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Hui Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China
| | | | - Qun Xia
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China.
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DiSilvestro KJ, Veeramani A, McDonald CL, Zhang AS, Kuris EO, Durand WM, Cohen EM, Daniels AH. Predicting Postoperative Mortality After Metastatic Intraspinal Neoplasm Excision: Development of a Machine-Learning Approach. World Neurosurg 2020; 146:e917-e924. [PMID: 33212282 DOI: 10.1016/j.wneu.2020.11.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Mortality following surgical resection of spinal tumors is a devastating outcome. Naïve Bayes machine learning algorithms may be leveraged in surgical planning to predict mortality. In this investigation, we use a Naïve Bayes classification algorithm to predict mortality following spinal tumor excision within 30 days of surgery. METHODS Patients who underwent laminectomies between 2006 and 2018 for excisions of intraspinal neoplasms were selected from the National Surgical Quality Initiative Program. Naïve Bayes classifier analysis was conducted in Python. The area under the receiver operating curve (AUC) was calculated to evaluate the classifier's ability to predict mortality within 30 days of surgery. Multivariable logistic regression analysis was performed in R to identify risk factors for 30-day postoperative mortality. RESULTS In total, 2094 spine tumor surgery patients were included in the study. The 30-day mortality rate was 5.16%. The classifier yielded an AUC of 0.898, which exceeds the predictive capacity of the National Surgical Quality Initiative Program mortality probability calculator's AUC of 0.722 (P < 0.0001). The multivariable regression indicated that smoking history, chronic obstructive pulmonary disease, disseminated cancer, bleeding disorder history, dyspnea, and low albumin levels were strongly associated with 30-day mortality. CONCLUSIONS The Naïve Bayes classifier may be used to predict 30-day mortality for patients undergoing spine tumor excisions, with an increasing degree of accuracy as the model better performs by learning continuously from the input patient data. Patient outcomes can be improved by identifying high-risk populations early using the algorithm and applying that data to inform preoperative decision making, as well as patient selection and education.
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Affiliation(s)
- Kevin J DiSilvestro
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ashwin Veeramani
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Andrew S Zhang
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Eren O Kuris
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Wesley M Durand
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Eric M Cohen
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
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Agathis AZ, Khetan P, Bitner D, Divino CM. Is preoperative anemia a significant risk factor for splenectomy patients? A NSQIP analysis. Surg Open Sci 2020; 2:101-106. [PMID: 32754713 PMCID: PMC7391880 DOI: 10.1016/j.sopen.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/19/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Prior literature has examined the association between preoperative anemia and complications across surgical settings; however, evidence is lacking for splenectomy patients. We investigated the association between preoperative hematocrit and 30-day postoperative outcomes in this population using a national database. Methods Patients who underwent splenectomy (2012–2017) were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Analyses were performed for the overall cohort and elective versus emergent subsets, adjusting for transfusion among other covariates. Results Our sample included 5,580 patients. As hematocrit decreased, complication rates increased incrementally in both the univariate and multivariate analyses. Adjusted odds ratios (and 95% confidence intervals) for moderate anemia (26% ≤ hematocrit < 30%) as compared to no anemia (hematocrit ≥ 38%) were readmission = 1.5 (1.1–1.8), sepsis = 2.2 (1.6–3.0), and composite outcome = 1.8 (1.0–3.2). Parameter estimates (standard error, P value) for the moderate versus no anemia group were length of stay = 3.0 (0.5, P < .001) and days to discharge = 1.2 (0.3; P < .001). Conclusion Our results demonstrate a dose-response relationship between increasing degree of anemia and odds of various postoperative adverse outcomes after adjusting for several potential confounders. The subset analysis further suggests that elective splenectomy cases are more likely to have poor outcomes when in the presence of anemia or when transfusions are performed as compared to emergent cases. This suggests that the harm associated with transfusion may offset the benefit of optimizing anemia in an elective splenectomy case.
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Affiliation(s)
- Alexandra Z Agathis
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Prerna Khetan
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Bitner
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Celia M Divino
- Division of General Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Boaro A, Wells M, Chi J, Lu Y, Smith TR, Groff MW, Zaidi H. A National Surgical Quality Improvement Program Analysis of Postoperative Major and Minor Complications in Patients with Spinal Metastatic Disease. World Neurosurg 2020; 140:e203-e211. [PMID: 32389869 DOI: 10.1016/j.wneu.2020.04.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Major complications after spine metastasis surgery are prioritized in the literature with little consideration of the more frequent minor events such as pneumonia or urinary tract infection. We analyzed incidence and risk factors of postsurgical complications in patients with spinal metastasis extracted from the National Surgical Quality Improvement Program (NSQIP). We also developed a useful predictive model to estimate the probability of occurrence of complications. METHODS A total of 1176 patients diagnosed with spinal metastasis were extracted from NSQIP. Variables screened included age, sex, tumor location, patient's functional status, comorbidities, laboratory values, and case urgency. Two multivariate logistic regression models were designed to evaluate risk factors and likelihood of event occurrence. RESULTS Minor events occurred twice as frequently compared with major complications (36% vs. 18% of patients). The most common major event was death (10%); the most frequent minor event was need for postoperative transfusion (29.4%). In the multivariate analysis, elderly age, emergency case, preoperative leukocytosis, and smoking status retained significance for major complications; American Society of Anesthesiologists classes 4-5, low hematocrit levels, and intradural extramedullary location of the tumor retained significance for minor complications. The predictive models designed explained 72% of the variability in major complications occurrence and 67% for minor events. CONCLUSIONS Smoking status and emergent surgery were found to be the strongest independent predictors of major complications, whereas higher American Society of Anesthesiologists class showed a greater association with minor events. The predictive models produced can be a useful aid for surgeons to identify those patients who are at greater risk of developing postoperative adverse events.
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Affiliation(s)
- Alessandro Boaro
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA.
| | - Michael Wells
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - John Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Michael W Groff
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Hasan Zaidi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
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Burton BN, Okwuegbuna O, Jafari A, Califano J, Brumund KT, Gabriel RA. Association of Preoperative Anemia With 30-Day Morbidity and Mortality Among Patients With Thyroid Cancer Who Undergo Thyroidectomy. JAMA Otolaryngol Head Neck Surg 2020; 145:124-131. [PMID: 30489623 DOI: 10.1001/jamaoto.2018.3099] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Despite the ease of preoperative anemia diagnosis and the availability of treatment options, the morbidity and mortality associated with this condition remain unacceptably high, and the literature describing the association of preoperative anemia with postoperative outcomes following thyroid surgery in patients with thyroid cancer remain sparse. Reporting outcomes in this patient population may help to facilitate preoperative optimization. Objective To assess whether an association exists between preoperative anemia and outcomes following thyroid surgery in patients with thyroid cancer. Design, Setting, and Participants This retrospective, cross-sectional, cohort study used the American College of Surgeons National Surgical Quality Improvement Program database to identify 32 166 patients between 2007 and 2016 with Current Procedural Terminology codes for thyroid surgery and with the International Classification of Diseases, Ninth Revision code of malignant thyroid cancer. Exposures Preoperative anemia as defined using the World Health Organization criteria of hematocrit less than 36% in nonpregnant females and less than 39% in males. Main Outcomes and Measures Multivariable logistic regression analysis was conducted to assess the association of preoperative anemia with the following 30-day postoperative outcomes: pulmonary, infectious, and cardiac complications, overall and serious morbidity (surgical site infection and medical complications), prolonged hospital length of stay (≥75th percentile for the cohort), and mortality. Results Among the 24 912 patients with thyroid cancer who underwent thyroidectomy included in the final analysis, the median (interquartile range) age was 51 (40-62) years and the majority were women (18 705 [75.1%]). The prevalence of preoperative anemia was 12.5% (n = 3108). Within the overall study population, hypertension (9242 patients [37.1%]) followed by active smoking (2992 patients [12.0%]) were the most prevalent comorbidities. The unadjusted odds of anemia vs no anemia were significantly higher for every 10-year increase in age (odds ratio [OR], 1.10; 95% CI, 1.08-1.13) and for black vs white patients (OR, 2.82; 95% CI, 2.51-3.17). The adjusted odds of postoperative overall morbidity (OR, 1.68; 95% CI, 1.29-2.17), mortality (OR, 3.36; 95% CI, 1.37-8.28), and pulmonary (OR, 2.36; 95% CI, 1.65-3.34) and infectious (OR, 1.62; 95% CI, 1.12-2.29) complications were higher in patients with preoperative anemia than in those without preoperative anemia. Conclusions and Relevance The findings from this study suggest that preoperative anemia may not only be associated with racial differences and a higher comorbidity burden but may also increase the likelihood of postoperative morbidity and mortality. These results may provide a basis for further risk reduction strategies and preoperative optimization.
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Affiliation(s)
| | | | - Aria Jafari
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla
| | - Joseph Califano
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla.,Moores Cancer Center, University of California San Diego Health, La Jolla
| | - Kevin T Brumund
- Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, La Jolla.,Moores Cancer Center, University of California San Diego Health, La Jolla
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, La Jolla.,Division of Biomedical Informatics, University of California, San Diego, La Jolla
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10
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Wang N, Desai A, Ge B, Li W, Jin X, Bai H, Yu K, Ye H. Prognostic value of hypoalbuminemia at diagnosis in de novo non-M3 acute myeloid leukemia. Leuk Lymphoma 2019; 61:641-649. [PMID: 31722601 DOI: 10.1080/10428194.2019.1686499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The association between serum albumin level and clinical outcomes has been reported for several hematological malignancies. Our study aimed to identify the relationship between serum albumin level at the time of diagnosis and subsequent clinical outcomes in patients with newly diagnosed acute myeloid leukemias (AMLs) other than acute promyelocytic leukemias (APLs). A total of 243 patients with de novo non-M3 AML were enrolled in this study. Variables including gender, age, serum albumin, white blood cell (WBC) count, hemoglobin (Hb), platelet (PLT) count, blasts at peripheral blood (PB) and bone marrow (BM), immunophenotype and cytogenetics at diagnosis, BM response after one course of chemotherapy and hematopoietic stem cell transplantation (HSCT) treatment were studied. We found that normal albumin level (serum albumin >3.5 g/dL) was significantly associated with superior overall survival (HR = 0.375, p < .001) and leukemia-free survival (HR = 0.411, p < .001). These results demonstrate that albumin could serve as a simple, cheap, and objective prognostication factor in refinement of AML regimens.
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Affiliation(s)
- Na Wang
- Health Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Aakash Desai
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Bei Ge
- Department of Infection Control, The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenya Li
- Wenzhou Medical University, Wenzhou, China
| | - Xianghong Jin
- Wenzhou Medical University, Wenzhou, China.,Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haige Ye
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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11
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Povolotskiy R, Cerasiello SY, Siddiqui SH, Baredes S, Eloy JA, Hsueh WD. Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity-matched analysis. Laryngoscope 2019; 130:1377-1382. [PMID: 31418868 DOI: 10.1002/lary.28228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Massive bleeding requiring blood transfusion is a feared complication of endoscopic sinus surgery (ESS). In an effort to improve healthcare quality and outcomes, research is focused on identifying the risk factors for complications following surgical procedures. Blood transfusions have been linked to increased complication rates, but their role has not been extensively studied in ESS. METHODS The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) participant user files 2005 to 2014 were queried for all cases of ESS. Patients were divided into cohorts based on anemia (hematocrit <39.00 in men and <36.00 in women) and hematocrit levels. Univariate analyses and a propensity score-matching algorithm were employed. RESULTS Of 630 cases of ESS, 117 (18.6%) had preexisting anemia. Anemic patients were more likely to be black (19.8% vs. 6.7%, P ≤ 0.001), undergo longer operation times (117.50 minutes ±155.73 vs. 129.85 minutes ±36.03, P = 0.005), have diabetes (28.2% vs. 10.9%, P ≤ 0.001), and have hypertension (46.2% vs. 33.1%, P = 0.010). Following propensity score matching, 109 cases were selected for each cohort, with no significant differences in demographics, comorbidities, operation time, or outpatient status. The anemic cohort was independently associated with an increase in overall postoperative complications (17.4% vs. 7.3%, P = 0.038). Transfusion use was significantly associated with preoperative hematocrit levels <30 (30.0% vs. 4.5%, P = 0.001) and between 30 and 34.99 (13.9% vs. 2.5%, P = 0.011). CONCLUSION Preoperative anemia is a significant predictor of overall complications and bleeding requiring transfusion for patients undergoing ESS. These results highlight the need for careful preoperative assessment and management of anemia in this population. LEVEL OF EVIDENCE NA Laryngoscope, 130:1377-1382, 2020.
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Affiliation(s)
- Roman Povolotskiy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Samantha Y Cerasiello
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Sana H Siddiqui
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Wayne D Hsueh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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12
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Yolcu Y, Wahood W, Alvi MA, Kerezoudis P, Habermann EB, Bydon M. Reporting Methodology of Neurosurgical Studies Utilizing the American College of Surgeons-National Surgical Quality Improvement Program Database: A Systematic Review and Critical Appraisal. Neurosurgery 2019; 86:46-60. [DOI: 10.1093/neuros/nyz180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/27/2019] [Indexed: 12/12/2022] Open
Abstract
AbstractBACKGROUNDUse of large databases such as the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has become increasingly common in neurosurgical research.OBJECTIVETo perform a critical appraisal and evaluation of the methodological reporting for studies in neurosurgical literature that utilize the ACS-NSQIP database.METHODSWe queried Ovid MEDLINE, EMBASE, and PubMed databases for all neurosurgical studies utilizing the ACS-NSQIP. We assessed each study according to number of criteria fulfilled with respect to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement, REporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) Statement, and Journal of American Medical Association–Surgical Section (JAMA-Surgery) Checklist. A separate analysis was conducted among papers published in core and noncore journals in neurosurgery according to Bradford's law.RESULTSA total of 117 studies were included. Median (interquartile range [IQR]) scores for number of fulfilled criteria for STROBE Statement, RECORD Statement, and JAMA-Surgery Checklist were 20 (IQR:19-21), 9 (IQR:8-9), and 6 (IQR:5-6), respectively. For STROBE Statement, RECORD Statement, and JAMA-Surgery Checklist, item 9 (potential sources of bias), item 13 (supplemental information), and item 9 (missing data/sensitivity analysis) had the highest number of studies with no fulfillment among all studies (56, 68, 50%), respectively. When comparing core journals vs noncore journals, no significant difference was found (STROBE, P = .94; RECORD, P = .24; JAMA-Surgery checklist, P = .60).CONCLUSIONWhile we observed an overall satisfactory reporting of methodology, most studies lacked mention of potential sources of bias, data cleaning methods, supplemental information, and external validity. Given the pervasive role of national databases and registries for research and health care policy, the surgical community needs to ensure the credibility and quality of such studies that ultimately aim to improve the value of surgical care delivery to patients.
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Affiliation(s)
- Yagiz Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Waseem Wahood
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Panagiotis Kerezoudis
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Cost-Utility Analysis of Surgery and Radiotherapy for Symptomatic Spinal Metastases in a Belgian Specialist Center. World Neurosurg 2019; 125:e537-e543. [DOI: 10.1016/j.wneu.2019.01.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/20/2022]
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14
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Serum alkaline phosphatase and 30-day mortality after surgery for spinal metastatic disease. J Neurooncol 2018; 140:165-171. [DOI: 10.1007/s11060-018-2947-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/09/2018] [Indexed: 12/23/2022]
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