PMID- 31561231
OWN - NLM
STAT- Publisher
LR  - 20240227
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
DP  - 2019 Sep 27
TI  - Perioperative adverse events following surgery for primary bone tumors of the 
      spine and en bloc resection for metastases.
PG  - 1-8
LID - 2019.6.SPINE19587 [pii]
LID - 10.3171/2019.6.SPINE19587 [doi]
AB  - OBJECTIVE: Surgical treatment of primary bone tumors of the spine and en bloc 
      resection for isolated metastases are complex and challenging. Operative care is 
      fraught with complications, though the true incidence and predictors of adverse 
      events (AEs), length of stay (LOS), and mortality in this population remain 
      poorly understood. The primary objective of this study was to describe the 
      incidence and predictors of perioperative AEs in these patients. Secondary 
      objectives included the determination of the incidence and predictors of 
      admission to the intensive care unit (ICU), unanticipated reoperation during the 
      same admission, hospital LOS, and mortality. METHODS: In this retrospective 
      analysis of prospectively collected data, the authors included consecutive 
      patients at a single quaternary care referral center (January 1, 2009, to 
      September 30, 2018) who underwent either surgery for a primary bone tumor of the 
      spine or an en bloc resection for an isolated spinal metastasis. Information on 
      perioperative AEs, demographic data, primary tumor histology, neurological 
      status, surgical variables, pathological margins, Enneking appropriateness, LOS, 
      ICU stay, reoperation during the same admission period, and in-hospital mortality 
      was collected prospectively in the institutional database. The modified frailty 
      score was extracted retrospectively. RESULTS: One hundred thirteen patients met 
      the inclusion criteria: 98 with primary bone tumors and 15 with isolated 
      metastases. The cohort was 59% male, and the mean age was 49 years (SD 19 years). 
      Overall, 79% of the patients experienced at least 1 AE. The median number of AEs 
      per patient was 2 (IQR 0-4 AEs), and the median LOS was 16 days (IQR 9-32 days). 
      No in-hospital deaths occurred in the cohort. Thirty-two patients (28%) required 
      an ICU stay and 19% underwent an unanticipated second surgery during their 
      admission. A longer surgical duration was associated with a higher likelihood of 
      AEs (OR 1.21/hour, 95% CI 1.06-1.37, p = 0.005), longer ICU stay (OR 1.35/hour, 
      95% CI 1 1.20-1.52, p < 0.001), and reoperation (OR 1.001/hour, 95% CI 
      1.0003-1.003, p = 0.012). Longer hospital LOS was independently predicted by 
      older age, female sex, upper cervical and sacral location of the tumor, surgical 
      duration, preoperative neurological deficit, presence of AEs, and higher modified 
      frailty index score. CONCLUSIONS: Surgeries for primary bone tumors and en bloc 
      resection for metastatic tumors are associated with a high incidence of 
      perioperative AEs. Surgical duration predicts complications, reoperation, LOS, 
      and ICU stay.
FAU - Charest-Morin, Raphaele
AU  - Charest-Morin R
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Flexman, Alana M
AU  - Flexman AM
AD  - 2Department of Anesthesiology, Pharmacology and Therapeutics, University of 
      British Columbia, Vancouver, British Columbia, Canada; and.
FAU - Srinivas, Shreya
AU  - Srinivas S
AD  - 3Department of Orthopaedics, Alder Hey Children's Hospital, NHS Foundation Trust, 
      Liverpool, United Kingdom.
FAU - Fisher, Charles G
AU  - Fisher CG
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Street, John T
AU  - Street JT
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Boyd, Michael C
AU  - Boyd MC
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Ailon, Tamir
AU  - Ailon T
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Dvorak, Marcel F
AU  - Dvorak MF
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Kwon, Brian K
AU  - Kwon BK
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Paquette, Scott J
AU  - Paquette SJ
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
FAU - Dea, Nicolas
AU  - Dea N
AD  - 1Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedic 
      Surgery, and.
LA  - eng
PT  - Journal Article
DEP - 20190927
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
OTO - NOTNLM
OT  - AE = adverse event
OT  - AUROC = area under the receiver operating characteristic
OT  - ICU = intensive care unit
OT  - LOS = length of stay
OT  - adverse event
OT  - en bloc resection
OT  - frailty
OT  - length of stay
OT  - mFI = modified frailty index
OT  - primary bone tumor of the spine
OT  - spinal oncology
EDAT- 2019/09/29 06:00
MHDA- 2019/09/29 06:00
CRDT- 2019/09/28 06:00
PHST- 2019/05/27 00:00 [received]
PHST- 2019/06/28 00:00 [accepted]
PHST- 2019/09/28 06:00 [entrez]
PHST- 2019/09/29 06:00 [pubmed]
PHST- 2019/09/29 06:00 [medline]
AID - 2019.6.SPINE19587 [pii]
AID - 10.3171/2019.6.SPINE19587 [doi]
PST - aheadofprint
SO  - J Neurosurg Spine. 2019 Sep 27:1-8. doi: 10.3171/2019.6.SPINE19587.