PMID- 25147976 OWN - NLM STAT- MEDLINE DCOM- 20150105 LR - 20220409 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 21 IP - 5 DP - 2014 Nov TI - Adverse events in emergency oncological spine surgery: a prospective analysis. PG - 698-703 LID - 10.3171/2014.7.SPINE131007 [doi] AB - OBJECT: Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome. Emergency oncological spine surgeries are generally palliative to reduce pain and improve patients' neurology and health-related quality of life. In individuals with limited life expectancy, AEs can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process. The purpose of this study was to determine the true incidence of AEs associated with emergency oncological spine surgery. METHODS: The authors carried out a prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected on standardized AE forms (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff. RESULTS: A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventy-six patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases. CONCLUSIONS: When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population. FAU - Dea, Nicolas AU - Dea N AD - Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada; and. FAU - Versteeg, Anne AU - Versteeg A FAU - Fisher, Charles AU - Fisher C FAU - Kelly, Adrienne AU - Kelly A FAU - Hartig, Dennis AU - Hartig D FAU - Boyd, Michael AU - Boyd M FAU - Paquette, Scott AU - Paquette S FAU - Kwon, Brian K AU - Kwon BK FAU - Dvorak, Marcel AU - Dvorak M FAU - Street, John AU - Street J LA - eng PT - Journal Article PT - Observational Study DEP - 20140822 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - *Emergency Treatment MH - Female MH - Humans MH - Length of Stay/statistics & numerical data MH - Male MH - Middle Aged MH - Orthopedic Procedures MH - Postoperative Complications/*epidemiology MH - Prospective Studies MH - Spinal Neoplasms/pathology/*surgery MH - Survival Rate OTO - NOTNLM OT - AE = adverse event OT - ASIA = American Spinal Injury Association OT - CCI = Charlson Comorbidity Index OT - SAVES V2 = Spine AdVerse Events Severity System, version 2 OT - adverse events OT - oncology OT - spinal metastasis OT - spine surgery EDAT- 2014/08/26 06:00 MHDA- 2015/01/06 06:00 CRDT- 2014/08/23 06:00 PHST- 2014/08/23 06:00 [entrez] PHST- 2014/08/26 06:00 [pubmed] PHST- 2015/01/06 06:00 [medline] AID - 10.3171/2014.7.SPINE131007 [doi] PST - ppublish SO - J Neurosurg Spine. 2014 Nov;21(5):698-703. doi: 10.3171/2014.7.SPINE131007. Epub 2014 Aug 22.