Surgical management of spinal metastasis is complex and can be associated with significant postoperative morbidity. Analyzing readmission rates may serve as a proxy for postoperative morbidity and functional decline, allowing patients and physicians to make informed decisions about treatment.
Retrospective analysis of patients with metastatic spine disease, surgically treated at a tertiary center from 2003-2012. Patients with primary lung, breast, kidney, bone marrow, prostate, gynecological, and melanoma were analyzed. The primary and secondary outcome variables were readmissions and overall survival, respectively. Multivariate Cox proportional hazards model was used to identify independent factors associated with readmissions.
159 patients were identified for analysis. Lung, breast and kidney represented the most common primary cancer sites, accounting for 22%, 19.5% and 16.4%, respectively. 56.6% of patients had at least one readmission, with a 30-day readmission rate of 13.8% and 1-year readmission rate of 47.2%. 26.7% of readmissions were for surgical complications, 33.7% for oncological disease progression, and 36.7% for other medical reasons. Patients with colorectal cancer had the highest number of readmissions. Interestingly, patients with melanoma had more readmissions over the course of their limited postoperative survival. Overall mortality was 59.1%, with a median survival of 15.1 months. Multivariate analysis revealed age above 60 and previous spine radiation increased the likelihood of being readmitted.
Readmissions provide an important window into understanding postoperative morbidity among patients with metastatic disease of the spine. This study offers an important starting point for understanding the nuances of patients' postoperative outcomes.
World neurosurgery. 2017 Feb 22 [Epub ahead of print]
Nancy Abu-Bonsrah, C Rory Goodwin, Rafael De la Garza-Ramos, Eric W Sankey, Ann Liu, Thomas Kosztowski, Benjamin D Elder, Chetan Bettegowda, Ali Bydon, Timothy F Witham, Jean-Paul Wolinsky, Ziya L Gokaslan, Daniel M Sciubba
Department of Neurosurgery, The Johns Hopkins University School of Medicine Baltimore, Maryland, USA., Department of Neurosurgery, The Johns Hopkins University School of Medicine Baltimore, Maryland, USA. Electronic address: ., Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.