Key result
A logistic regression-based nomogram predicted postoperative adverse events within 90 days after lumbar fusion surgery in elderly patients, demonstrating a C-index of 0.69 in external validation.
Why the study?
Identifying elderly patients at high risk of postoperative adverse events after TLIF is critical to optimize perioperative management and healthcare costs.
Cohort (n=1,200)
Yes
Effect estimate: C-index 0.69 (95% CI 0.65-0.76)
A logistic regression-based nomogram can effectively predict the risk of 90-day postoperative adverse events in elderly patients undergoing lumbar fusion surgery, aiding in individualized perioperative management.
Nomogram may aid perioperative risk stratification in elderly lumbar fusion; leaves open clinical adoption pending prospective validation.
BACKGROUND: The burden of lumbar degenerative diseases (LDD) has increased substantially with the unprecedented aging population. Identifying elderly patients with high risk of postoperative adverse events (AEs) and establishing individualized perioperative management is critical to mitigate added costs and optimize cost-effectiveness to the healthcare system. We aimed to develop a predictive tool for AEs in elderly patients with transforaminal lumbar interbody fusion (TLIF), utilizing multivariate logistic regression, single classification and regression tree (hereafter, "classification tree"), and random forest machine learning algorithms. METHODS: This study was a retrospective review of a prospective Geriatric Lumbar Disease Database (age ≥ 65). Our outcome measure was postoperative AEs, including prolonged hospital stays, postoperative complications, readmission, and reoperation within 90 days. Patients were grouped as either having at least one adverse event (AEs group) or not (No-AEs group). Three models for predicting postoperative AEs were developed using training dataset and internal validation using testing dataset. Finally, online tool was developed to assess its validity in the clinical setting (external validation). RESULTS: The development set included 1025 patients (mean [SD] age, 72.8 [5.6] years; 632 [61.7%] female), and the external validation set included 175 patients (73.2 [5.9] years; 97 [55.4%] female). The predictive ability of our three models was comparable, with no significant differences in AUC (0.73 vs. 0.72 vs. 0.70, respectively). The logistic regression model had a higher net benefit for clinical intervention than the other models. A nomogram based on logistic regression was developed, and the C-index of external validation for AEs was 0.69 (95% CI 0.65-0.76). CONCLUSION: The predictive ability of our three models was comparable. Logistic regression model had a higher net benefit for clinical intervention than the other models. Our nomogram and online tool ( https://xuanwumodel.shinyapps.io/Model_for_AEs/ ) could inform physicians about elderly patients with a high risk of AEs within the 90 days after TLIF surgery.
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Wang et al. (2024) conducted a cohort in Lumbar degenerative diseases (n=1,200). Logistic regression nomogram vs. Classification tree and random forest models was evaluated on Predictive accuracy (C-index) for postoperative adverse events within 90 days (C-index 0.69, 95% CI 0.65-0.76). A logistic regression-based nomogram predicted postoperative adverse events within 90 days after lumbar fusion surgery in elderly patients, demonstrating a C-index of 0.69 in external validation.
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