Surgical results and clinical risks of postoperative complications in patients with painful malignant spinal cord compression after decompressive surgery

Abstract

IntroductionThis study aims to analyze clinical outcome in patients with painful malignant spinal cord compression due to advanced cancers after the decompressive surgery and identify risk factors for postoperative complications in these patients. Furthermore, we created a scoring model to predict the risk of postoperative complications based on identified significant risk factors.MethodsWe retrospectively analyzed survival outcomes, pain outcomes, and postoperative complications of patients with painful malignant spinal cord compression who were surgically treated in our department. Identification of risk factors for postoperative complications was also performed, and significant factors according to the multiple logistic regression models were included in the scoring model.ResultsAs a result, 105 patients were enrolled. The overall median survival time was 9.1 months (95% CI, 7.1–11.4 months). The mean worst pain score was 8.0 in a 24-hour period before surgery, while it decreased to 6.0, 5.0, 3.5, 3.3, and 3.6 (all P<0.01, when compared with baseline date) at 1 week, 1 month, 3, 6, and 12 months after surgery, respectively. Similar decreases were also observed in the average pain and the pain interference. Thirty-one complications occurred within 4 weeks after operation in 26 patients (24.8%, 26/105). Based on multiple logistic regression models, age (P=0.03), Karnofsky performance status (P<0.01), and Charlson Comorbidity Index (P=0.04) were significantly associated with postoperative complications and were included in the scoring model. Three risk groups were created based on the complication rates of each scoring points. The corresponding postoperative complication rates of the three groups were 7.7% in group A (0–3 points), 26.7% in group B (4–6 points), and 60.9% in group C (7–10 points), respectively (OR, 4.32, 95% CI: 2.24–8.31, P<0.01).ConclusionDecompressive surgery for painful malignant spinal cord compression was found to be useful for pain control with a tolerable rate of complications. We created a scoring model to predict the risk of postoperative complications in patients with painful malignant spinal cord compression after surgery. This scoring model may guide doctors to choose the appropriate care strategies to realize better pain management.

A comparative study of spinal cord compression management in metastatic prostate cancer: Teaching versus non‐teaching hospitals in the United States

“…25 Although elevated Charlson comorbidity scores are associated with increased risk of postoperative complications significant differences in management of patients with similar comorbidity scores is a concerning finding and indicates inconsistency in clinical practice/decision-making despite well-established guidelines. 14 Among the 11,380 patients in our cohort, the median cost of hospitalization was $21,922 in teaching hospitals, vs $15,141 in non-teaching hospitals, both higher than prior literature and indicative of the rising costs associated with cancer-related care. 26 The difference in cost between teaching and non-teaching hospitals is striking, as the cost of admission in teaching hospital was nearly one standard deviation above prior documented costs of admission for metastatic cancer.…”

“…Furthermore, while over 95% of both cohorts had Charlson comorbidity scores of over 4, prior literature indicates that surgical cord decompression can be performed in patients with Charlson scores >6, particularly in older patient populations, with significant neurologic improvement 25 . Although elevated Charlson comorbidity scores are associated with increased risk of postoperative complications significant differences in management of patients with similar comorbidity scores is a concerning finding and indicates inconsistency in clinical practice/decision‐making despite well‐established guidelines 14 …”

“…In unstable patients who are not good surgical candidates, interventional radiology procedures may have additional utility 12 . While steroids are always indicated, the choice between radiation and surgical intervention depends on several factors, including tumor radiosensitivity, spinal instability, and medical comorbidities 11,13,14 . When possible, combining surgical decompression with radiation therapy may yield superior clinical outcomes 15 .…”

“…12 While steroids are always indicated, the choice between radiation and surgical intervention depends on several factors, including tumor radiosensitivity, spinal instability, and medical comorbidities. 11,13,14 When possible, combining surgical decompression with radiation therapy may yield superior clinical outcomes. 15 Despite well-established evidence for the management of cord compression, management of spinal cord compression varies based on patient's clinical status, race and insurance status.…”

Predicting Survival in Patients Presenting With Spinal Epidural Metastases: The Limburg Spinal Metastasis Score

“…In the literature, similar numbers (13%-27%) are presented. 9,11,52,53 This study has several limitations, including its retrospective nature. Furthermore, only surgically treated patients were evaluated; patients who were deemed unfit for surgery were not included for analysis.…”