Development of a scoring scale for predicting the risk of postoperative complications after spinal tuberculosis debridement: A retrospective cohort study of 233 patients

Abstract

Background: This investigation established a scoring scale for predicting the incidence of postoperative complications in patients after spinal tuberculosis debridement. Methods: A total of 232 spinal tuberculosis patients who underwent debridement surgery between January 2012 to May 2020 were included in this retrospective study. The study cohort was divided into 2 groups according to the presence or absence of postoperative complications. The complications were defined as abnormal or impaired body function caused by surgical factors (such as nerve injury and internal fixation looseness) or other factors (such as chemotherapy and bed stay). Clinical characteristics include age, body mass index (BMI), diabetes mellitus, pulmonary tuberculosis, smoking history, preoperative serum albumin, preoperative C-reactive protein (CRP), Cobb angle correction, surgical approach, operation time, etc. operative blood loss was recorded and analyzed. The clinical characteristics of spinal tuberculosis patients who suffered postoperative complications were evaluated, and a scoring scale was established using logistic regression analysis. The performance of this scoring scale was prospectively validated. Results: Out of 232 patients, a total of 188 (81.03%) suffered postoperative complications after surgery. Multivariate binary logistic regression analysis showed that diabetes mellitus [adjusted odds ratio (OR) =1.110, P=0.046], pulmonary tuberculosis (adjusted OR =1.181, P=0.002), low preoperative serum albumin (adjusted OR =0.789, P=0.005), anterior surgical approach (adjusted OR =5.934, P=0.035), and long operation time (adjusted OR =1.019, P<0.01) were independent risk factors of postoperative complications after spinal tuberculosis debridement surgery. The above independent risk factors were assigned to establish a scoring scale for predicting postoperative complications, and receiver operating characteristic (ROC) analysis showed that the optimal cut-off value for the scoring scale was 4 points. The sensitivity and specificity of the scoring scale were 60.8% and 81.8%, respectively, based on the validation set. Conclusions: Using the scoring scale, spinal tuberculosis patients with a score between 4 to 9 would be considered at high risk of postoperative complications, while patients with a score of 0 to 3 would likely be at low risk of developing postoperative complications.