Abstract
•Patient survival is a key consideration when determining treatment for spinal metastasis.•Physician predictions for life expectancy in the setting of metastatic cancer are often inaccurate.•The SORG machine learning algorithms accurately predict risk of 90-day and 1-year mortality in patients undergoing surgery for spinal metastasis.•With an independent cohort of 298 patients treated between 2004 and 2020, we report successful external validation of the SORG algorithms for preoperative risk prediction of 90-day and 1-year mortality after surgery for spinal metastasis.
Surgical decompression and stabilization in the setting of spinal metastasis is performed to relieve pain and preserve functional status. These potential benefits must be weighed against the risks of perioperative morbidity and mortality. Accurate prediction of a patient's postoperative survival is a crucial component of patient counseling.
To externally validate the SORG machine learning algorithms for prediction of 90-day and 1-year mortality after surgery for spinal metastasis.
Retrospective, cohort study
Patients 18 years or older at a tertiary care medical center treated surgically for spinal metastasis
Mortality within 90 days of surgery, mortality within 1 year of surgery
This is a retrospective cohort study of 298 adult patients at a tertiary care medical center treated surgically for spinal metastasis between 2004 and 2020. Baseline characteristics of the validation cohort were compared to the derivation cohort for the SORG algorithms. The following metrics were used to assess the performance of the algorithms: discrimination, calibration, overall model performance, and decision curve analysis.
Sixty-one patients died within 90 days of surgery and 133 died within 1 year of surgery. The validation cohort differed significantly from the derivation cohort. The SORG algorithms for 90-day mortality and 1-year mortality performed excellently with respect to discrimination; the algorithm for 1-year mortality was well-calibrated. At both postoperative time points, the SORG algorithms showed greater net benefit than the default strategies of changing management for no patients or for all patients.
With an independent, contemporary, and geographically distinct population, we report successful external validation of SORG algorithms for preoperative risk prediction of 90-day and 1-year mortality after surgery for spinal metastasis. By providing accurate prediction of intermediate and long-term mortality risk, these externally validated algorithms may inform shared decision-making with patients in determining management of spinal metastatic disease.
