Abstract
Introduction
Several scoring systems have evolved to estimate life expectancy in the setting of spinal metastases. However, neither overall mortality rate nor risk factors for complications in open surgery for spinal metastatic fractures have been well defined. We hypothesize that the mortality risk for these patients is high, and that additional medical comorbidities add substantially to the risk of early postoperative death. Understanding these risks will help us to choose surgical candidates with more carefully.
Methods
A national database, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) files, from 2011–2013 were queried for patients who underwent open surgery for pathologic vertebral fracture in the setting of metastatic cancer. Patients were analyzed for rates of any adverse event (AAE), readmission, reoperation, and mortality. Bivariate and multivariate analyses were performed to determine independent risk factors for these events.
Results
Of the one hundred and fifty three patients identified, seventy-eight (51%) experienced AAE, fifteen (9.8%) required reoperation, thirty (19.6%) were readmitted, and nineteen (12.4%) died within 30 days. Risk factors for AAE included pulmonary comorbidity (p = 0.049, OR=3.87) and chronic steroid use (p = 0.045, OR=2.28). Reoperation risk factors included male gender (p = 0.038, OR=4.00). No risk factors were identified for readmission. Regarding mortality, identified risk factors included dependent functional status (p = 0.009, OR=5.75), diabetes (p = 0.004, OR=5.55), and pulmonary comorbidity (p = 0.041, OR=4.23).
Conclusion
Open surgery for spinal metastatic fractures carries significant morbidity and mortality. Greater than half of patients in this cohort experienced an adverse event, nearly 20% were readmitted, and greater than 10% died within 30 days. Patient factors, including pulmonary disease, diabetes, and dependent functional status, were identified as risk factors for poor outcomes. Thorough preoperative counseling should be performed for patients with our proposed risk factors, and the risk of mortality in surgery must be carefully weighed against life expectancy and neurological deficits.