James Feghali1, Elizabeth Marinaro1, Daniel Lubelski1, Mark G Luciano1, Judy Huang2. 1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jhuang24@jhmi.edu.
Abstract
BACKGROUND: Patient counselling and selection for surgical therapy in adult Chiari malformation type I (CM-1) remains debatable. We aimed to develop a clinical calculator predicting the risk of non-home discharge and re-operation using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: The database from years 2011 through 2017 was queried to identify the subset of CM-1 patients undergoing suboccipital decompression. Univariable analysis was conducted to identify baseline factors associated with non-home discharge and 30-day re-operation following the initial decompression procedure. Logistic regression and the Akaike Information Criterion were used to identify the optimal models predictive of both outcomes. Performance was assessed using receiver operating curves and validated with bootstrapping. RESULTS: In 706 CM-1 patients, the rate of non-home discharge was 5.2%, and the re-operation rate was 6.6% with most re-operations consisting of CSF flow diversion and CSF leak repair. The optimal model predictive of non-home discharge consisted of age (odds ratio [OR]=1.05, p=0.001), diabetes (OR=2.44, p=0.080), and ASA class (OR=1.94, p=0.082) with an area under the curve (AUC) of 0.720. The optimal model predictive of re-operation consisted of female sex (OR=0.48, p=0.031), BMI (OR=1.05, p=0.002), and ASA class (OR=3.44, p=0.001) with an AUC of 0.726. A calculator for both outcomes was deployed under the following URL: https://jhuspine3.shinyapps.io/Discharge_Reop_Calculator/. CONCLUSION: We have used a large international database to develop a simple risk calculator based on readily available pre-operative variables. Following subsequent validation, this tool can help optimize patient counselling and decision-making in adult CM-1.
BACKGROUND:Patient counselling and selection for surgical therapy in adult Chiari malformation type I (CM-1) remains debatable. We aimed to develop a clinical calculator predicting the risk of non-home discharge and re-operation using the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: The database from years 2011 through 2017 was queried to identify the subset of CM-1 patients undergoing suboccipital decompression. Univariable analysis was conducted to identify baseline factors associated with non-home discharge and 30-day re-operation following the initial decompression procedure. Logistic regression and the Akaike Information Criterion were used to identify the optimal models predictive of both outcomes. Performance was assessed using receiver operating curves and validated with bootstrapping. RESULTS: In 706 CM-1 patients, the rate of non-home discharge was 5.2%, and the re-operation rate was 6.6% with most re-operations consisting of CSF flow diversion and CSF leak repair. The optimal model predictive of non-home discharge consisted of age (odds ratio [OR]=1.05, p=0.001), diabetes (OR=2.44, p=0.080), and ASA class (OR=1.94, p=0.082) with an area under the curve (AUC) of 0.720. The optimal model predictive of re-operation consisted of female sex (OR=0.48, p=0.031), BMI (OR=1.05, p=0.002), and ASA class (OR=3.44, p=0.001) with an AUC of 0.726. A calculator for both outcomes was deployed under the following URL: https://jhuspine3.shinyapps.io/Discharge_Reop_Calculator/. CONCLUSION: We have used a large international database to develop a simple risk calculator based on readily available pre-operative variables. Following subsequent validation, this tool can help optimize patient counselling and decision-making in adult CM-1.