Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor

Yamada, Kentaro; Yoshii, Toshitaka; Toba, Mikayo; Kudo, Akira; Egawa, Satoru; Matsukura, Yu; Hirai, Takashi; Inose, Hiroyuki; Fushimi, Kiyohide; Okawa, Atsushi

doi:10.1097/brs.0000000000004718

Cited by 4 publications

(2 citation statements)

References 33 publications

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“…The outcomes of gait ability were evaluated by unexpected ambulatory status for surgical treatment for spinal stenosis. "Unfavorable" was de ned as (1) non-ambulatory at discharge or (2) ambulatory status deterioration calculated according to a previous report [21].…”

Section: Discussionmentioning

confidence: 99%

Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020

Yamada,

Yoshii,

Toba

et al. 2024

Int J Clin Oncol

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Background.Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. Methods.The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. Results.This study analyzed 10321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37 days-30 days, p < 0.001). The postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. Conclusion.During the last decade, surgical treatment for spinal metastasis has increased in Japan. In-hospital mortality and length of stay decreased. The results of this study may provide useful information for healthcare policy or clinical research planning.

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Section: Discussionmentioning

confidence: 99%

Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020

Yamada,

Yoshii,

Toba

et al. 2024

Int J Clin Oncol

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“…e read with great interest the study by Yamada et al 1 that analyzed the factors associated with postoperative unfavorable ambulatory status following surgery for metastatic spinal tumors using a nationwide in-hospital database. Of the patients, 33% experienced postoperative unfavorable ambulatory status.…”

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Letter to Editor Concerning “Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor” by Yamada et al

Toda,

Morimoto,

Hirata

et al. 2023

Spine

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Response to Letter to the Editor Concerning “Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor”

Yamada,

Yoshii,

Toba

et al. 2024

Spine

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e read the letter to the editor regarding our study with great interest and appreciate the authors for this opportunity to respond to it. In the original published article, we addressed the risk factors for postoperative unfavorable ambulatory status: (1) nonambulatory at discharge or (2) a decreased mobility score of the Barthel Index between admission and discharge, using a Japanese nationwide in-hospital database. The surgical procedure of laminectomy alone, as well as male, preoperative nonambulatory status, and preoperative comorbidity, were detected as independently associated factors. 1 Among these, the preoperative ambulatory status was the factor that most strongly affected the postoperative unfavorable ambulatory status (adjusted odds ratio 6.66, P < 0.001). However, as the letter to the editor pointed out, preoperative ambulatory status in each surgical method was not described in the original article. Thus, we have additionally demonstrated the ratio of nonambulatory status in each method in Table 1. There were more preoperative nonambulatory patients in the laminectomy alone procedure and more ambulatory patients in the vertebroplasty when compared with patients in the posterior fusion procedure. While the preoperative ambulatory status varied among the surgical methods (Table 1), the analysis in the original article was performed with adjusting preoperative ambulatory status as well as other confounding factors. Therefore, we consider that the positive association between laminectomy alone procedure and postoperative unfavorable status is valid for discussion.Meanwhile, one of the major limitations of the Diagnosis Procedure Combination (DPC) database is that the clinical data is available only during hospitalization. Therefore, the administration of pre/postoperative chemotherapy/bonemodifying agents or patients' survival after discharge could not be obtained from the DPC database. Furthermore, perioperative estimated blood loss or operative time could not be extracted from the DPC database.In agreement with the letter, we consider that further detailed and longer follow-up research would support or improve the results of our study.

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Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor

Cited by 4 publications

References 33 publications

Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020

Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020

Letter to Editor Concerning “Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor” by Yamada et al

Response to Letter to the Editor Concerning “Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor”

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