Surgical treatment of primary bone tumors of the spine and en bloc resection for isolated metastases are complex and challenging. Operative care is fraught with complications, though the true incidence and predictors of adverse events (AEs), length of stay (LOS), and mortality in this population remain poorly understood. The primary objective of this study was to describe the incidence and predictors of perioperative AEs in these patients. Secondary objectives included the determination of the incidence and predictors of admission to the intensive care unit (ICU), unanticipated reoperation during the same admission, hospital LOS, and mortality.
In this retrospective analysis of prospectively collected data, the authors included consecutive patients at a single quaternary care referral center (January 1, 2009, to September 30, 2018) who underwent either surgery for a primary bone tumor of the spine or an en bloc resection for an isolated spinal metastasis. Information on perioperative AEs, demographic data, primary tumor histology, neurological status, surgical variables, pathological margins, Enneking appropriateness, LOS, ICU stay, reoperation during the same admission period, and in-hospital mortality was collected prospectively in the institutional database. The modified frailty score was extracted retrospectively.
One hundred thirteen patients met the inclusion criteria: 98 with primary bone tumors and 15 with isolated metastases. The cohort was 59% male, and the mean age was 49 years (SD 19 years). Overall, 79% of the patients experienced at least 1 AE. The median number of AEs per patient was 2 (IQR 0–4 AEs), and the median LOS was 16 days (IQR 9–32 days). No in-hospital deaths occurred in the cohort. Thirty-two patients (28%) required an ICU stay and 19% underwent an unanticipated second surgery during their admission. A longer surgical duration was associated with a higher likelihood of AEs (OR 1.21/hour, 95% CI 1.06–1.37, p = 0.005), longer ICU stay (OR 1.35/hour, 95% CI 1 1.20–1.52, p < 0.001), and reoperation (OR 1.001/hour, 95% CI 1.0003–1.003, p = 0.012). Longer hospital LOS was independently predicted by older age, female sex, upper cervical and sacral location of the tumor, surgical duration, preoperative neurological deficit, presence of AEs, and higher modified frailty index score.
Surgeries for primary bone tumors and en bloc resection for metastatic tumors are associated with a high incidence of perioperative AEs. Surgical duration predicts complications, reoperation, LOS, and ICU stay.
ABBREVIATIONSAE = adverse event; AUROC = area under the receiver operating characteristic; ICU = intensive care unit; LOS = length of stay; mFI = modified frailty index.
Correspondence Raphaële Charest-Morin: University of British Columbia, Vancouver, BC, Canada. email@example.com.INCLUDE WHEN CITING Published online September 27, 2019; DOI: 10.3171/2019.6.SPINE19587.Disclosures Dr. Fisher reports being a consultant for Medtronic and NuVasive; he receives royalties and fellowship support from Medtronic and fellowship support from AOSpine. Dr. Dea reports being a consultant for Stryker and Baxter; he owns stock in Medtronic.