Introduction: The purpose of this study is to use a large national registry to evaluate 30-day incidence and main risk factors for complications following surgery for spinal metastasis in the neurosurgical practice.
Methods: Data were extracted from the National Surgical Quality Improvement Program (NSQIP) registry for patients who underwent surgery for spinal metastases in the neurosurgical environment between 2005 and 2015. The incidence of major and minor complications (neurological, cardiovascular, renal, infective) was extracted. The variables screened included age, sex, American Society of Anesthesiologists (ASA) class, comorbidities, preoperative functional status and preoperative laboratory values, smoking status. The Fisher exact test was used to compute the odds ratio and p value between each variable subgroup and the reference.
Results: Among the 620 patients included the most common major complications recorded were: deep venous thrombosis (4.8%), sepsis (2%), and unplanned reintubation (2%). Among the subgroup of minor complications the most frequent resulted: unplanned blood transfusions(30%), followed by pneumonia (4.3%) and urinary tract infection (3.2%). Factors presenting greater associated risk for developing minor complications included: ASA class 3-5, diabetes with insulin intake, disseminated cancer, dyspnea, partially dependent functional status, pre-operative albumin < 3.5 g/dl, pre-operative hematocrit > 36%, preoperative sodium < 135 mEq/L, and preoperative weight loss (p < 0.05). Factors with associated risk for major complications included: age >69, dyspnea, partially dependent functional status, and preoperative alkaline phosphatase > 147 IU/L (p < 0.05).
Conclusions: In this NSQIP analysis the overall incidence of major and minor complications in patients undergoing surgery for spinal metastasis in the neurosurgical practice was 26% (excluding the blood transfusion occurrence). Only the presence of dyspnea and a partially dependent functional status appeared to be a risk factor for both groups. This preliminary results may contribute to the creation of a predictive model to risk-stratify patients preoperatively and to the interdisciplinary neurosurgical and orthopaedic management of these patients.
Patient Care: This analysis may be the basis for a following registry or multi-institutional based prediction model to risk-stratify patients with spinal metastasis preoperatively in the neurosurgical care.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Aknowledge the main complications following surgery for spinal metastasis, 2) Discuss potential factors to be considered in the creation of a predictive model to risk-stratify patients.