The LACE+ index fails to predict 30-90 day readmission for supratentorial craniotomy patients: A retrospective series of 238 surgical procedures

Objective: The LACE + index (Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months) is a tool utilized to predict 30-90 day readmission and other secondary outcomes. We sought to examine the effectiveness of this predictive tool in patients undergoing brain tumor surgery.

Patients and methods: Admissions and readmissions for patients undergoing craniotomy for supratentorial neoplasm at a single, multi-hospital, academic medical center, were analyzed. Key data was prospectively collected with the Neurosurgery Quality Improvement Initiative (NQII)-EpiLog tool. This included all supratentorial craniotomy cases for which the patient was alive at 90 days after surgery (n = 238). Simple logistic regression analyses were used to assess the ability of the LACE + index and subsequent single variables to accurately predict the outcome measures of 30-90 day readmission, 30-90 day emergency department (ED) visit, and 30-90 day reoperation. Analysis of the model's or variable's discrimination was determined by the receiver operating characteristic curve as represented by the C-statistic.

Results: The sample included admissions for craniotomy for supratentorial neoplasm (n = 238) from 227 patients, of which 50.00% were female (n = 119). The average LACE + index score was 53.48 ± 16.69 (Range 9-83). The LACE + index did not accurately predict 30-90 day readmissions (P = 0.127), 30-90 day ED visits (P = 0.308), nor reoperations (P = 0.644). ROC confirmed that the LACE + index was little better than random chance at predicting these events in this population (C-statistic = 0.51-0.58). However, a single unit increase in LACE + leads to a 0.97 times reduction in the odds of being discharged home with fair predictive accuracy (P < 0.001, CI = 0.96-0.98, C-statistic = 0.69).

Conclusion: The results of this study show that the LACE + index is ill-equipped to predict 30-90 day readmissions in the brain tumor population and further analysis of significant covariates or other prediction tools should be undertaken.