Preoperatively-determined Red Distribution Width (RDW) predicts prolonged length of stay after single-level spinal fusion in elderly patients

Anton Früh; Dietmar Frey; Adam Hilbert; Claudius Jelgersma; Christian Uhl; Nitzan Nissimov; Peter Truckenmüller; David Wasilewski; Dimitrios Rallios; Matthias Hoppe; Simon Bayerl; Nils Hecht; Peter Vajkoczy; Lars Wessels

Brain and Spine (Jan 2024)

Preoperatively-determined Red Distribution Width (RDW) predicts prolonged length of stay after single-level spinal fusion in elderly patients

Anton Früh,
Dietmar Frey,
Adam Hilbert,
Claudius Jelgersma,
Christian Uhl,
Nitzan Nissimov,
Peter Truckenmüller,
David Wasilewski,
Dimitrios Rallios,
Matthias Hoppe,
Simon Bayerl,
Nils Hecht,
Peter Vajkoczy,
Lars Wessels

Affiliations

Anton Früh: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany
Dietmar Frey: CLAIM – Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
Adam Hilbert: CLAIM – Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
Claudius Jelgersma: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Christian Uhl: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Nitzan Nissimov: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Peter Truckenmüller: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
David Wasilewski: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Dimitrios Rallios: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Matthias Hoppe: Medical Faculty Leipzig, Leipzig University, Leipzig, Germany
Simon Bayerl: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Nils Hecht: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Peter Vajkoczy: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Lars Wessels: Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Corresponding author. Charité – Universitätsmedizin Berlin, Berlin, Germany, Charitéplatz 1, 10117, Berlin, Germany.

Journal volume & issue: Vol. 4
p. 102827

Abstract

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Introduction: Elderly patients receiving lumbar fusion surgeries present with a higher risk profile, which necessitates a robust predictor of postoperative outcomes. The Red Distribution Width (RDW) is a preoperative routinely determined parameter that reflects the degree of heterogeneity of red blood cells. Thereby, RDW is associated with frailty in hospital-admitted patients. Research question: This study aims to elucidate the potential of RDW as a frailty biomarker predictive of prolonged hospital stays following elective mono-segmental fusion surgery in elderly patients. Material and methods: In this retrospective study, we included all patients with age over 75 years that were treated via lumbar single-level spinal fusion from 2015 to 2022 at our tertiary medical center. Prolonged length of stay (pLOS) was defined as a length ≥ the 3rd quartile of LOS of all included patients. Classical correlation analysis, Receiver-operating characteristic (ROC) and new machine learning algorithms) were used. Results: A total of 208 patients were included in the present study. The median age was 77 (IQR 75–80) years. The median LOS of the patients was 6 (IQR 5–8) days. The data shows a significant positive correlation between RDW and LOS. RDW is significantly enhanced in the pLOS group. New machine learning approaches with the imputation of multiple variables can enhance the performance to an AUC of 71%. Discussion and conclusion: RDW may serve as a predictor for a pLOS in elderly. These results are compelling because the determination of this frailty biomarker is routinely performed at hospital admission. An improved prognostication of LOS could enable healthcare systems to distribute constrained hospital resources efficiently, fostering evidence-based decision-making processes.

Published in Brain and Spine

ISSN: 2772-5294 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: https://www.journals.elsevier.com/brain-and-spine

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