Special Poster Session 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Establishment of a Nomogram for Assessing the Risk of Ambulatory Surgery Conversion to Extended Stay for Lumbar Decompression Patients. (#SP-8e)

Koki Tsuchiya 1 2 , Gisberto Evangelisti 1 3 , Ichiro Okano 2 , Yusuke Dodo 2 , Paul Kohil 1 4 , Jan Hambrecht 1 , Ali Guven 1 , Soji Tani 2 , Erika Chiapparelli 1 , Jennifer Shue 1 , Frank P Cammisa 1 , Federico P Girardi 1 , Alexander P Hughes 1 , Andrew A Sama 1
  1. Hospital for special surgery, New York, United States
  2. Showa university, Orthopedic surgery, Tokyo, Japan
  3. Instituto Ortopedico Rizzoli, Bologna, Italy
  4. Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany

 

Introduction

Spine ambulatory surgery (AMS) is reported to have similar quality of care compared to conventional inpatient spine surgery. Recently, AMS for lumbar decompression has increased due to its cost-effectiveness and safety. However, there are certain AMS patients who unexpectedly stay in the hospital for a longer time and several studies have identified risk factors for this AMS conversion. Nomograms are used to calculate the possibility of generating clinical events through complex computational formulas. With the help of nomograms, clinicians can assess the risk of clinical events. This study aimed to develop and validate a clinical predictive nomogram for risk factors for AMS conversion to extended stay for lumbar decompression patients.

Material and Methods

The electronic medical records of all patients who underwent lumbar decompression surgery planned as AMS between 2019 and 2020, were retrospectively reviewed. Relevant data affecting AMS conversion to extended stay were collected. Predictors were screened using univariate and multi-factor logistic analysis to construct a nomogram. The nomogram was validated using a validation cohort.

Results

The data of 1096 AMS patients was included for establishing the nomogram using multivariable regression model and setting AMS conversion as the outcome variable. The conversion rate from AMS to extended stay was 58%. Age >80 years (Odds ratio 4.00, 95% confidence interval (CI) 1.47-12.6), estimated blood loss (Odds ratio 1.00, 95% CI 1.00-1.00), drain use (Odds ratio 1.83, 95% CI 1.33-2.51) and surgery duration time (Odds ratio 1.01, 95% CI 1.00-1.00) were identified for risk factors of AMS conversion. A nomogram was made using these results.

Conclusion

In this study, we established a nomogram effectively predicting ambulatory surgery conversion to extended stay among lumbar decompression patients. This nomogram can be used for screening high-risk patients of AMS conversion.

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  1. Li W, Wang H, Dong S, et al. Establishment and validation of a nomogram and web calculator for the risk of new vertebral compression fractures and cement leakage after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. Eur Spine J 2022;31:1108-21.
  2. Dodo Y, Okano I, Kelly NA, et al. Risk Factors for Ambulatory Surgery Conversion to Extended Stay Among Patients Undergoing One-level or Two-level Posterior Lumbar Decompression. Spine (Phila Pa 1976) 2023;48:748-57.