Development and Validation of a Preoperative Nomogram for Predicting Prolonged Hospital Stay After Spinal Tuberculosis Surgery.

OBJECTIVE

The purpose of this study was to determine the risk factors that affect prolonged length of stay (LOS) after debridement, bone grafting, fusion and internal fixation for spinal tuberculosis, and to establish and validate a prediction model.

METHODS

A retrospective study was conducted on 102 patients hospitalized for spinal tuberculosis at a single center from September 2017 to January 2024. Using the 75th percentile of length of stay as the cut-off value, a stay ≥13 days was defined as prolonged LOS. Univariate and binary logistic regression analyses were performed to identify independent risk factors. A nomogram prediction model was developed and its performance was evaluated using the area under the receiver operating characteristic curve AUC with internal validation.

RESULTS

The average length of stay was (10.63±3.01) days, with 26 patients (25.5%) having prolonged length of stay. Binary Logistic regression showed that Emaciation (OR=6.598, 95% CI 1.264-42.462, P=0.031), severe pain (OR=10.776, 95% CI 2.613-56.910, P=0.002), elevated Erythrocyte sedimentation Rate (OR=1.091, 95% CI 1.025-1.183, P=0.014) and elevated C-reactive protei (OR=1.076, 95% CI 1.027-1.141, P=0.005) were independent risk factors. The AUC of the joint prediction model was 0.928 (95% CI: 0.878-0.977), indicating good predictive value.

CONCLUSION

Emaciation, severe pain, elevated Erythrocyte sedimentation Rate and elevated C-reactive protein are independent risk factors for prolonged length of stay after surgery for spinal tuberculosis. The developed nomogram can assist clinicians in preoperative identification of high-risk patients and optimizing perioperative management strategies.