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Spinal Metastasis Surgery: A Proposal for a Predictive Model of Morbidity and Mortality[*]Article in several languages: português | English
07 June 2018
06 August 2018
25 September 2019 (online)
Objective To develop a predictive model of early postoperative morbidity and mortality with the purpose of assisting in the selection of the candidates for spinal metastasis surgery.
Methods A retrospective analysis of consecutive patients operated for metastatic spinal disease. The possible prognostic preoperative characteristics were gender, age, comorbidities, tumor growth rate, and leukocyte and lymphocyte count in the peripheral blood. The postoperative outcomes were 30-day mortality, 90-day mortality and presence of complications. A predictive model was developed based on factors independently associated with these three outcomes. The final model was then tested for the tendency to predict adverse events, discrimination capacity and calibration.
Results A total of 205 patients were surgically treated between 2002 and 2015. The rates of the 30-day mortality, 90-day mortality and presence of complications were of 17%, 42% and 31% respectively. The factors independently associated with these three outcomes, which constituted the predictive model, were presence of comorbidities, no slow-growing primary tumor, and lymphocyte count below 1,000 cells/µL. Exposure to none, one, two or three factors was the criterion for the definition of the following categories of the predictive model: low, moderate, high and extreme risk respectively. Comparing the risk categories, there was a progressive increase in the occurrence of outcomes, following a linear trend. The discrimination capacity was of 72%, 73% and 70% for 30-day mortality, 90-day mortality and complications respectively. No lack of calibration occurred.
Conclusion The predictive model estimates morbidity and mortality after spinal metastasis surgery and hierarchizes risks as low, moderate, high and extreme.
Keywordsspine/surgery - comorbidity - lymphocytes - morbidity - mortality - neoplasm metastasis - postoperative complications
* Study developed at Hospital Erasto Gaertner by the Post-Graduate Program in Surgical Clinic of Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil.
- 1 Patil CG, Lad SP, Santarelli J, Boakye M. National inpatient complications and outcomes after surgery for spinal metastasis from 1993-2002. Cancer 2007; 110 (03) 625-630
- 2 Cohen J, Alan N, Zhou J, Kojo Hamilton D. The 100 most cited articles in metastatic spine disease. Neurosurg Focus 2016; 41 (02) E10
- 3 Rades D, Huttenlocher S, Dunst J. , et al. Matched pair analysis comparing surgery followed by radiotherapy and radiotherapy alone for metastatic spinal cord compression. J Clin Oncol 2010; 28 (22) 3597-3604
- 4 Finkelstein JA, Zaveri G, Wai E, Vidmar M, Kreder H, Chow E. A population-based study of surgery for spinal metastases. Survival rates and complications. J Bone Joint Surg Br 2003; 85 (07) 1045-1050
- 5 Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT. Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine 1999; 24 (18) 1943-1951
- 6 Schoenfeld AJ, Le HV, Marjoua Y. , et al. Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS). Spine J 2016; 16 (04) 482-490
- 7 Patchell RA, Tibbs PA, Regine WF. , et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366 (9486): 643-648
- 8 Choi D, Fox Z, Albert T. , et al. Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort. Br J Neurosurg 2016; 30 (03) 337-344
- 9 Ibrahim A, Crockard A, Antonietti P. , et al. Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007. J Neurosurg Spine 2008; 8 (03) 271-278
- 10 Quan GM, Vital JM, Aurouer N. , et al. Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients. Eur Spine J 2011; 20 (11) 1970-1978
- 11 Tokuhashi Y, Uei H, Oshima M, Ajiro Y. Scoring system for prediction of metastatic spine tumor prognosis. World J Orthop 2014; 5 (03) 262-271
- 12 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
- 13 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
- 14 Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine 2001; 26 (03) 298-306
- 15 Haynes AB, Weiser TG, Berry WR. , et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360 (05) 491-499
- 16 Rampersaud YR, Moro ER, Neary MA. , et al. Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine 2006; 31 (13) 1503-1510
- 17 R Core Team. RA language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2016
- 18 BVBA. MedCalc Software. Ostende, Bélgica: 2017
- 19 George R, Jeba J, Ramkumar G, Chacko AG, Leng M, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev 2008; (04) CD006716
- 20 Schoenfeld AJ, Leonard DA, Saadat E, Bono CM, Harris MB, Ferrone ML. Predictors of 30- and 90-Day Survival Following Surgical Intervention for Spinal Metastases: A Prognostic Study Conducted at Four Academic Centers. Spine 2016; 41 (08) E503-E509
- 21 Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 2005; 30 (19) 2186-2191
- 22 Arrigo RT, Kalanithi P, Cheng I. , et al. Charlson score is a robust predictor of 30-day complications following spinal metastasis surgery. Spine 2011; 36 (19) E1274-E1280
- 23 Brass D, McKay P, Scott F. Investigating an incidental finding of lymphopenia. BMJ 2014; 348: g1721
- 24 Bharadwaj S, Ginoya S, Tandon P. , et al. Malnutrition: laboratory markers vs nutritional assessment. Gastroenterol Rep (Oxf) 2016; 4 (04) 272-280
- 25 Trédan O, Ray-Coquard I, Chvetzoff G. , et al. Validation of prognostic scores for survival in cancer patients beyond first-line therapy. BMC Cancer 2011; 11: 95
- 26 Luksanapruksa P, Buchowski JM, Hotchkiss W, Tongsai S, Wilartratsami S, Chotivichit A. Prognostic factors in patients with spinal metastasis: a systematic review and meta-analysis. Spine J 2017; 17 (05) 689-708
- 27 Chi JH, Gokaslan Z, McCormick P, Tibbs PA, Kryscio RJ, Patchell RA. Selecting treatment for patients with malignant epidural spinal cord compression-does age matter?: results from a randomized clinical trial. Spine 2009; 34 (05) 431-435
- 28 Laufer I, Rubin DG, Lis E. , et al. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist 2013; 18 (06) 744-751
- 29 Ghori AK, Leonard DA, Schoenfeld AJ. , et al. Modeling 1-year survival after surgery on the metastatic spine. Spine J 2015; 15 (11) 2345-2350