Readmissions After Surgical Resection of Metastatic Tumors of the Spine at a Single Institution

Abu-Bonsrah, Nancy; Goodwin, C. Rory; Ramos, Rafael De la Garza; Sankey, Eric W.; Liu, Ann; Kosztowski, Thomas; Elder, Benjamin D.; Bettegowda, Chetan; Bydon, Ali; Witham, Timothy F.; Wolinsky, Jean Paul; Gokaslan, Ziya L.; Sciubba, Daniel M.

doi:10.1016/j.wneu.2017.02.065

Cited by 22 publications

(20 citation statements)

References 25 publications

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“…To that end, unplanned readmissions is an important metric that can have a significant impact on cost as well as serve as an indicator of morbidity associated with these procedures. Two recent single center studies of 164 and 159 patients looked at readmissions after surgery for metastatic spinal disease (48,49). Thirty-day readmission rates were from 13.8-16.8% and 1-year readmissions were 37.8-47.2%, with approximately 33% due to recurrent disease, 25% due to infection, and 37-43% as a result of medical complications.…”

Section: Complicationsmentioning

confidence: 99%

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Yahanda¹,

Buchowski²,

Wegner³

2019

Ann. Transl. Med

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Spinal metastases are common in patients with cancer. As cancer treatments improve and these patients live longer, the number who present with metastatic spine disease will increase. Treatment strategies for these patients continues to evolve. In particular, since the prospective randomized controlled study in 2005 by Patchell et al. showed increased survival with decompressive surgical treatment of spinal metastases, there is a growing body of literature focusing on surgical management and complications of surgery for this disease. Surgery is often one component of a multimodal treatment approach with chemotherapy and radiation, which makes it difficult to parse the benefits of each individual treatment in outcome studies. Additionally, there has been more recent emphasis placed on patient-reported outcomes (PRO) after treatment for metastatic spine disease. In this review, we summarize treatments of metastatic spinal disease, possible perioperative complications, and validated tools used to assess outcomes for these patients.

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Section: Complicationsmentioning

confidence: 99%

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Yahanda¹,

Buchowski²,

Wegner³

2019

Ann. Transl. Med

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“… 16 Surgery has proved to be the most effective intervention in patients with neurological deficits and bony instability. 17 , 18 However, this is not without risk, as more than 10% of these patients must be re-operated on often due to hardware failure or other complications, 19 , 20 which can become a costly burden on the health care system. 21 Additionally, tumor recurrence and continuous local bone loss lead to the importance requirement for systemic chemo- and antiresorptive therapy.…”

Section: Discussionmentioning

confidence: 99%

Zoledronic Acid Versus Denosumab for Prevention of Spinal Cord Compression in Advanced Cancers With Spine Metastasis: A Meta-Analysis of Randomized Controlled Trials

Farii

Frazer

Farahdel

et al. 2019

Global Spine Journal

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Study Design: Meta-analysis of randomized controlled trials (RCTs). Objectives: The aim was to analyze the efficacy of zoledronic acid (ZA) versus denosumab in the prevention of spinal cord compression in patients with spine metastases from advanced cancers, by evaluating all available RCTs on this subject. Methods: A systematic search of electronic databases (PubMed and MEDLINE) was performed to identify all published RCTs comparing ZA with denosumab in prevention of spinal cord compressions in spine metastases. Risk of bias of the studies was assessed. The primary outcomes evaluated were spinal cord compression. Results: Three RCTs (5274 patients) were included. Denosumab was not significantly superior to ZA in reducing the likelihood of spinal cord compression, when all tumor types were combined (odds ratio [OR] 0.92, 95% confidence interval [CI; 0.66, 1.28], P = .66). Denosumab was not significantly favored over ZA in endodermal origin (breast and prostate; OR 0.72, 95% CI [0.43, 1.19], P = .20) and mesodermal origin tumors (solid tumors and multiple myeloma; OR 1.10, 95% CI [0.72, 1.69], P = .66). Conclusion: Denosumab does not significantly reduce the likelihood of spinal cord compressions in comparison to ZA in patients with spine metastases. When spinal cord compressions were grouped by tumor origin (endodermal or mesodermal), there remained no significant difference between denosumab and ZA. Further long-term studies are needed to determine the effectiveness of these treatment regimens.

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“…[33][34][35] Additionally, patient-specific factors (e.g., nutrition status), operative factors (e.g., number of operated vertebral levels), postoperative complications, and tumor-specific factors (e.g., primary tumor type) are also shown to impact length of stay and in-hospital complications in MSD patients. [36][37][38][39] In our study, transferred patients were more likely to develop in-hospital complications, particularly pulmonary complications, deep venous thrombosis, and gastrointestinal complications. The transferred cohort had a more severe clinical presentation and evidence of more advanced systemic disease, which was most likely associated with the higher rate of medical complications, prolonged length of stay, and nonroutine discharge in this group.…”

Section: In-hospital Mortalitymentioning

confidence: 99%

Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications

Ramos

Park²,

McCray³

et al. 2021

Neurosurgical Focus

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OBJECTIVE In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD. METHODS The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes. RESULTS Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18–1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16–1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46–1.98, p < 0.001), with no significant difference in inpatient mortality rates. CONCLUSIONS Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.

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Readmissions After Surgical Resection of Metastatic Tumors of the Spine at a Single Institution

Cited by 22 publications

References 25 publications

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

Zoledronic Acid Versus Denosumab for Prevention of Spinal Cord Compression in Advanced Cancers With Spine Metastasis: A Meta-Analysis of Randomized Controlled Trials

Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications

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