Introduction: Excisional laminectomy of spinal neoplasms is commonly performed. The objective of this study is to examine the risk profile associated with elective laminectomies of benign, malignant primary, and secondary/metastatic neoplasms of the thoracic spine.
Methods: Adult patients undergoing elective thoracic laminectomy and excision of a spinal neoplasm were abstracted from ACS-NSQIP years 2011-2014. Patients were classified into three cohorts: benign primary, malignant primary, secondary/metastatic. Univariate and multivariate analyses compared outcomes of operation time, early complications, hospital length of stay (HLOS), and discharge destination across cohorts.
Results: In total, 186 patients were included and mean age was 57.54±15.2-years. Mean operation time was 214.83±120.93 minutes and HLOS was 5.98±6.90 days; no significant differences were observed across neoplasm cohorts. Early complications were observed in 15.0% of patients with secondary/metastatic patients associating with increased odds of blood transfusion. Overall, 32.2% of patients failed to be discharged to home (benign primary-30.8%, malignant primary-66.6%, secondary/metastatic-10.5%; p<0.001). On multivariable analysis, the malignant primary cohort associated with increased odds of failure to be discharged to home (OR 5.08, 95% CI [1.64, 15.72]; p=0.005).
Conclusions: Comparable performance on operation time and HLOS between spine neoplasm cohorts suggests broad indication of excisional laminectomy for elective treatment. Primary thoracic spine tumors may present increased considerations in the acute setting and require a higher level of early post-discharge care. Future studies are needed to confirm these findings.
Patient Care: By providing the largest study of patients undergoing operative treatment for a thoracic spine neoplasm we hope to help inform and characterize surgical decision making in an extremely common procedure.
Learning Objectives: This presentation will enable participants to:
1) Characterize the clinical presentation of various thoracic spine tumors.
2) Identify the most common complications patients undergoing elective laminectomy and neoplasm excision experience.
3) Understand the increased risk primary thoracic spine tumors present in contrast to their benign or metastatic counterparts.