Thirty-day Outcomes After Surgery for Metastatic Bone Disease of the Extremities

Abstract

Introduction: Metastatic bone disease of the extremities is a notable cause of morbidity and mortality. Surgical management is not curative; therefore, risks and benefits of surgery must be carefully considered. Previous studies of surgical outcomes are limited by small sample sizes because of the rare incidence of these procedures. In this study, we aim to describe the rates of complications and mortality in the first 30 days after surgical treatment of metastatic bone disease of the femur and humerus. Methods: A retrospective review of patients in the National Surgical Quality Improvement Program database who underwent surgery between 2005 and 2016 was performed. Demographics, comorbidities, preoperative factors, surgical parameters, and postoperative complications were extracted. The cohort was also partitioned by surgical site and surgical modality. Results: One thousand one hundred fifty-four patients were identified, 13.1 percent of patients experienced one or more complications within 30 days of surgery. The most common complications were urinary tract infection (2.9%), deep vein thrombosis (2.5%), pneumonia (2.4%), pulmonary embolism (2.0%), and surgical site infections (1.9%). In addition, intraoperative or postoperative bleeding requiring transfusion occurred in 32.9% of cases. The rates of unplanned readmission and unplanned revision surgery were 12.7% and 4.1%, respectively. The 30-day mortality rate was 7.1%. Femur and arthroplasty cases were associated with a higher risk of bleeding requiring transfusion. Prophylactic stabilization was associated with a lower risk of unplanned revision surgery (P = 0.015) and a lower overall complication rate (P < 0.0001). Conclusion: Our study demonstrates a higher 30-day mortality rate than previously reported. In additon, prophylactic stabilization of impending pathologic fractures may be associated with a lower risk of complications and unplanned revision surgery. The National Surgical Quality Improvement Program or other large database reports can help surgeons counsel patients appropriately regarding the risks and benefits of surgery.

What’s New in Musculoskeletal Tumor Surgery

“…Several recent articles have analyzed aspects of the care of patients with these diseases. Gallaway et al performed a national database review of morbidity and mortality after surgical procedures for metastatic disease of the humerus and femur; the 30-day mortality was 7.1%, with postoperative complications and morbidity being common 21 . These authors observed significantly lower risks of revision and complications with prophylactic surgery, highlighting the value of identifying and treating these patients early in the course of the disease and adding to the literature supporting prophylactic surgery.…”

Current concepts in metastatic carcinoma: a review of the literature

“…Skeletal complications of metastatic bone disease include bone pain, pathologic fracture, decreased quality of life, bone marrow aplasia, and hypercalcemia of malignancy. 1 Metastatic carcinoma is the most common malignancy treated by orthopaedic surgeons. Treatment of bone lesions is very important for these patients with regard to quality of life.…”

Preoperative coagulation biomarkers associate with survival and pulmonary embolism after surgical treatment of non-spinal skeletal metastases

“…In patients with surgically treated skeletal metastases, the incidence rate of thromboembolic complications is even higher, despite thromboprophylaxis. Their rate for deep venous thrombosis (DVT) is 2-11%; and that of pulmonary embolism (PE) 2-9%, and for lethal PE under 1% to over 3% [1,[8][9][10][11]. The overall postoperative mortality rate is high, ranging from more than 7% during the first 30 days to between 38 and 47% at 1 year [8][9][10][11][12].…”

“…Their rate for deep venous thrombosis (DVT) is 2-11%; and that of pulmonary embolism (PE) 2-9%, and for lethal PE under 1% to over 3% [1,[8][9][10][11]. The overall postoperative mortality rate is high, ranging from more than 7% during the first 30 days to between 38 and 47% at 1 year [8][9][10][11][12].…”