• Neurosurgery · Nov 2020

    The LACE+ Index as a Predictor of 90-Day Supratentorial Tumor Surgery Outcomes.

    • Eric Winter, Debanjan Haldar, Gregory Glauser, Ian F Caplan, Kaitlyn Shultz, Scott D McClintock, ChenHan-Chiao IsaacHIDepartment of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Jang W Yoon, and Neil R Malhotra.
    • Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
    • Neurosurgery. 2020 Nov 16; 87 (6): 1181-1190.

    BackgroundThe LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index [CCI] score, and Emergency department [ED] visits in the past 6 mo) index risk-prediction tool has never been successfully tested in a neurosurgery population.ObjectiveTo assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tumor surgery.MethodsLACE+ scores were retrospectively calculated for all patients (n = 624) who underwent surgery for supratentorial tumors at the University of Pennsylvania Health System (2017-2019). Confounding variables were controlled with coarsened exact matching. The frequency of unplanned hospital readmission, ED visits, and death was compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, and Q4).ResultsA total of 134 patients were matched between Q1 and Q4; 152 patients were matched between Q2 and Q4; and 192 patients were matched between Q3 and Q4. Patients with higher LACE+ scores were significantly more likely to be readmitted within 90 d (90D) of discharge for Q1 vs Q4 (21.88% vs 46.88%, P = .005) and Q2 vs Q4 (27.03% vs 55.41%, P = .001). Patients with larger LACE+ scores also had significantly increased risk of 90D ED visits for Q1 vs Q4 (13.33% vs 30.00%, P = .027) and Q2 vs Q4 (22.54% vs 39.44%, P = .039). LACE+ score also correlated with death within 90D of surgery for Q2 vs Q4 (2.63% vs 15.79%, P = .003) and with death at any point after surgery/during follow-up for Q1 vs Q4 (7.46% vs 28.36%, P = .002), Q2 vs Q4 (15.79% vs 31.58%, P = .011), and Q3 vs Q4 (18.75% vs 31.25%, P = .047).ConclusionLACE+ may be suitable for characterizing risk of certain perioperative events in a patient population undergoing supratentorial brain tumor resection.Copyright © 2020 by the Congress of Neurological Surgeons.

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