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

Neurosurgery 2020 DOI:10.1093/neuros/nyaa225

The 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.

OBJECTIVE: To assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tumor surgery.

METHODS: LACE+ 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).

RESULTS: A total of 134 patients were matched between Q1 and Q4; 152 patients were matched between Q2 andQ4; 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 forQ2 vsQ4 (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).

CONCLUSION: LACE+ may be suitable for characterizing risk of certain perioperative events in a patient population undergoing supratentorial brain tumor resection.