Related Experiment Video
Updated: Jan 7, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Association of LACE+ Index and Postoperative Disposition Needs in a Matched Spinal Oncology Population
Emily Xu1, Jason Kost2, Kristen Park1
1Department of Neurosurgery, University of Pennsylvania, Philadelphia , Pennsylvania , USA.
Background And Objectives:
Treatment of spinal tumors is complex and resource-intensive. The LACE+ index is a validated tool for predicting postoperative readmission and mortality. It incorporates length of stay, acuity of admission, comorbidity (Charlson index), and emergency visits and age, sex, and previous admissions (LACE+). This study assessed whether the LACE+ index has predictive value in patients undergoing spinal tumor surgery.
Methods:
Data on patients undergoing spinal oncology surgery (n = 757) with preoperative LACE+ index were collected. Most patients underwent posterior instrumented aiming for gross total resection. Coarsened exact matching was used to account for confounding variables and assess the predictive value of LACE+. Patients with a LACE+ score in the top 50% of the study cohort (score >58, n = 169) were compared with matched patients in the bottom 50% (score ≤58, n = 169). Outcomes assessed included 30- and 90-day emergency department visits, readmissions, reoperations, nonhome discharges, and mortality.
Results:
The cohort included primary (42.8%), metastatic (56.0%), and unknown spinal tumors (1.2%), with a mean age of 58 years (range 18-88). There were 386 patients with LACE+ ≤58 (51%) and 371 patients with LACE+ >58 (49%). Patients with high LACE+ scores were significantly more likely to be readmitted 30 (Odds ratios [OR] 1.91 [1.13, 3.19], P = .0169) and 90 days (OR 1.86 [1.17, 2.94], P = .0097) after surgery when compared with otherwise matched patients with a low LACE+ score. High LACE+ score patients were also more likely to require postacute care after discharge (OR 2.33 [1.48, 3.66], P = .0001) and have higher mortality rates at 90 days (OR 3.4 [1.25, 9.215], P = .0169). There were no differences in postoperative emergency department visits or reoperations.
Conclusion:
The LACE+ index can prospectively predict readmission, nonhome discharge, and mortality for spinal oncology patients after surgery. Application of the LACE+ index may help risk stratify and guide management of spinal tumor patients in the perioperative setting.
