Comparison of three predictive scoring systems for morbidity in oncological spine surgery

Estimating complications in oncological spine surgery is challenging. The objective of this study was to compare the accuracy of three scoring systems for predicting perioperative morbidity after surgery for spinal metastases. One-hundred and five patients who underwent surgery between 2013 and 2019 were included in this study. All patients had scores retrospectively calculated using the New England Spinal Metastasis Score (NESMS), Metastatic Spinal Tumor Frailty Index (MSTFI), and Anzuategui scoring systems. The main outcome measure was development of a medical complication (minor or major) within 30 days of surgery. The predictive ability for each system was assessed using receiver operating characteristic analysis and calculations of the area under the curve (AUC). The average age for all patients was 61 years and 61/105 patients (58.1%) were male. The most common primary tumor origins were hematologic (23.8%), prostate (16.2%), breast (14.3%), and lung (13.3%). The overall 30-day complication rate was 36.2% and the rate of major complications was 21.9%. Among all patients who underwent oncological spine surgery, the NESMS score had the highest AUC for 30-day overall (AUC 0.64; 95% CI, 0.53 - 0.75) and major morbidity (AUC 0.68; 95% CI, 0.54- 0.81) in our population. However, the accuracy did not meet the threshold for clinical utility. Future prospective validation of these systems in other populations is encouraged.