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Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery

Presented at the 2020 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Michael M. H. Yang, Jay Riva-Cambrin, Jonathan Cunningham, Nathalie Jetté, Tolulope T. Sajobi, Alex Soroceanu, Peter Lewkonia, W. Bradley Jacobs and Steven Casha

perioperative settings to improve pain. The goals of this study were to 1) establish the predictors of poorly controlled postoperative pain after elective spine surgery and 2) develop and internally validate a clinical prediction score to aid clinicians in risk-stratifying patients in the preoperative setting. Methods This study was conducted and reported in accordance with the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement. 10 Ethics approval for this study was provided by the University of Calgary

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Cecilia L. Dalle Ore, Robert C. Rennert, Alexander J. Schupper, Brandon C. Gabel, David Gonda, Bradley Peterson, Lawrence F. Marshall, Michael Levy and Hal S. Meltzer

Risk of blunt cerebrovascular injury (BCVI) was calculated using the BCVI clinical prediction score described in Ravindra et al.: 38 GCS score ≤ 8 corresponded to 1 point, focal neurological deficit to 2 points, carotid canal fracture 2 points, petrous temporal bone fracture 3 points, and cerebral infarct on CT to 3 points. Patients with scores of greater than 3 out of a possible total 11 points were designated high risk for BCVI. Neuroworsening was defined as described in Morris et al. 30 Outcomes were classified using the Glasgow Outcomes Scale (GOS) based on

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Zoher Ghogawala

Gerbershagen HJ , Pogatzki-Zahn E , Aduckathil S , Procedure-specific risk factor analysis for the development of severe postoperative pain . Anesthesiology . 2014 ; 120 ( 5 ): 1237 – 1245 . 2 Yang MMH , Riva-Cambrin J , Cunningham J , Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery . J Neurosurg Spine . Published online September 15, 2020. doi:10.3171/2020.5.SPINE20347 3 Nguyen L-CL , Sing DC , Bozic KJ . Preoperative reduction of opioid use before total joint

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Vijay M. Ravindra, Jay Riva-Cambrin, Walavan Sivakumar, Ryan R. Metzger and Robert J. Bollo

.6–13.0) Cerebral infarct on CT 0.010 5.8 (1.5–21.8) Fracture through the carotid canal 0.002 4.3 (1.7–10.8) Petrous temporal bone fracture 0.004 6.8 (1.9–24.6) * Risk factors that were also analyzed but were not statistically significant (p > 0.05) included high-energy blunt injury, Rotterdam score > 3, skull base fracture, spine fracture, and hanging. Development of a Clinical Prediction Score The results from this study cohort were used to create a prediction model ( Table 3 ) and included the 5 variables identified as being independently

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Hesham Mostafa Zakaria, Azam Basheer, David Boyce-Fappiano, Erinma Elibe, Lonni Schultz, Ian Lee, Farzan Siddiqui, Brent Griffith and Victor Chang

J , Cai S , Englesbe MJ , Holcombe S , Wang S : Sarcopenia as a prognostic factor among patients with stage III melanoma . Ann Surg Oncol 18 : 3579 – 3585 , 2011 45 Schoenfeld AJ , Le HV , Marjoua Y , Leonard DA , Belmont PJ Jr , Bono CM , : Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS) . Spine J 16 : 482 – 490 , 2016 46 Sheetz KH , Zhao L , Holcombe SA , Wang SC , Reddy RM

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Victoria L. Morgan, Baxter P. Rogers, Adam W. Anderson, Bennett A. Landman and Dario J. Englot

seizure outcome. The results showed that the mean squared error was lower when the set of FC parameters was included (two-sample t-test, p < 0.0001, 95% CI −0.98 to −0.56), suggesting the association of FC parameters and long-term outcome. In contrast, the SC parameters, hippocampal volumes, and clinical prediction scores provided no additional predictive information. To further investigate the individual FC parameters, the regression was repeated with 1000 bootstrap trials using only the 28 FC parameters. The FC between the contralateral hippocampus and precuneus was

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Andreas Fahlström, Henrietta Nittby Redebrandt, Hugo Zeberg, Jiri Bartek Jr., Andreas Bartley, Lovisa Tobieson, Maria Erkki, Amel Hessington, Ebba Troberg, Sadia Mirza, Parmenion P. Tsitsopoulos and Niklas Marklund

: American Society of Anesthesiologists Classification (ASA Class) . StatPearls [Internet] . Treasure Island, FL: StatPearls Publishing LLC, 2018 ( https://www.ncbi.nlm.nih.gov/books/NBK441940/ ) [Accessed June 21, 2019] 11 Feigin VL , Lawes CM , Bennett DA , Barker-Collo SL , Parag V : Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review . Lancet Neurol 8 : 355 – 369 , 2009 12 Garrett JS , Zarghouni M , Layton KF , Graybeal D , Daoud YA : Validation of clinical prediction scores

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Andreas Fahlström, Henrietta Nittby Redebrandt, Hugo Zeberg, Jiri Bartek Jr., Andreas Bartley, Lovisa Tobieson, Maria Erkki, Amel Hessington, Ebba Troberg, Sadia Mirza, Parmenion P. Tsitsopoulos and Niklas Marklund

incidence and early case fatality reported in 56 population-based studies: a systematic review . Lancet Neurol 8 : 355 – 369 , 2009 19233729 10.1016/S1474-4422(09)70025-0 12 Garrett JS , Zarghouni M , Layton KF , Graybeal D , Daoud YA : Validation of clinical prediction scores in patients with primary intracerebral hemorrhage . Neurocrit Care 19 : 329 – 335 , 2013 10.1007/s12028-013-9926-y 24132566 13 Gregson BA , Broderick JP , Auer LM , Batjer H , Chen XC , Juvela S , : Individual patient data subgroup meta-analysis of surgery

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Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

Presented at the 2020 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Elie Massaad, Muhamed Hadzipasic, Christopher Alvarez-Breckenridge, Ali Kiapour, Nida Fatima, Joseph H. Schwab, Philip Saylor, Kevin Oh, Andrew J. Schoenfeld, Ganesh M. Shankar and John H. Shin

: external validation . J Surg Oncol . 2017 ; 115 ( 8 ): 1019 – 1027 . 16 Ghori AK , Leonard DA , Schoenfeld AJ , Modeling 1-year survival after surgery on the metastatic spine . Spine J . 2015 ; 15 ( 11 ): 2345 – 2350 . 17 Schoenfeld AJ , Le HV , Marjoua Y , Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS) . Spine J . 2016 ; 16 ( 4 ): 482 – 490 . 18 Katagiri H , Okada R , Takagi T , New prognostic factors

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Aditya V. Karhade, Viren S. Vasudeva, Hormuzdiyar H. Dasenbrock, Yi Lu, William B. Gormley, Michael W. Groff, John H. Chi and Timothy R. Smith

, Ramirez PT , Soliman PT , : Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies . Gynecol Oncol 128 : 204 – 208 , 2013 77 Schoenfeld AJ , Le HV , Marjoua Y , Leonard DA , Belmont PJ Jr , Bono CM , : Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS) . Spine J 16 : 482 – 490 , 2016 78 Sciubba DM