Artikel
The 30-day mortality in patients with surgically treated spinal metastases – a critical analysis of 209 patients
Die 30-Tage Mortalität bei chirurgisch behandelten Patienten mit spinalen Metastasen – kritische Analyse von 209 Patienten
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Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Spinal metastasis is a major cause of morbidity in cancer patients, leading to severe pain syndromes, spinal instability and neurological deficits. In this context, surgery for patients with spinal metastasis provides a promising benefit. But the treatment success is difficult to predict and the morbidity and mortality of surgical procedures is high. Established clinical prediction rules focus on the life expectancy and not on the short term follow up. The aim of this study was to determine the 30-day mortality rate and to assess the ability of different CPR to predict the short term mortality in patients with spinal metastasis.
Methods: A retrospective analysis of surgically treated patients of spinal metastasis was performed in a six-year period. We extracted various clinical variables from the patients’ medical charts and our database. The CPR of Tomita and Tokuhashi were determined. A chi-square testwas used to compare the 30-day mortality among different diagnoses. Multivariate logistic regression assessed whether Tomita and Tokuhashi score were independent predictors of 30-day mortality.
Results: We identified a 30-day mortality rate of 0.10 (21/209). The leading cause of death was a rapid progress of the primary tumor (nine cases), followed by respiratory insufficiency (six cases), for the other six patients we found no cause of death in the documentation. Minor surgical complications were present in one case. Among the different diagnoses, patients with lung cancer had a significant (p<0.05) higher rate of 30-day mortality (8/47) than patients with non-lung cancer (13/162). Multivariate logistic regression show that Tokuhashi Score (OR 0.34; p 0.001) but not the revised Tomita score was a predictor for 30-day mortality.
Conclusion: Spine surgery might appear promising from the surgeon’s point of view in the context of spinal metastasis. But it must be explained to the patient that even the short term mortality is high after surgery for spinal metastasis, notably in case of lung cancer. A briefly evaluation of the individual situation might help to stratify the patients risk and to avoid futile treatment.