Surgery for metastatic spinal disease in octogenarians and above: Analysis of 78 patients Journal Article
| Authors: | Hussain, I.; Hartley, B. R.; McLaughlin, L.; Reiner, A. S.; Laufer, I.; Bilsky, M. H.; Barzilai, O. |
| Article Title: | Surgery for metastatic spinal disease in octogenarians and above: Analysis of 78 patients |
| Abstract: | Study Design: Retrospective Cohort Study. Objective: Octogenarians living with spinal metastases are a challenging population to treat. Our objective was to identify the rate, types, management, and predictors of complications and survival in octogenarians following surgery for spinal metastases. Methods: A retrospective review of a prospectively collected cohort of patients aged 80 years or older who underwent surgery for metastatic spinal tumor treatment between 2008 and 2019 were included. Demographic, intraoperative, complications, and postoperative follow-up data was collected. Cox proportional hazards regression and logistic regression were used to associate variables with overall survival and postoperative complications, respectively. Results: 78 patients (mean 83.6 years) met inclusion criteria. Average operative time and blood loss were 157 minutes and 615 mL, respectively. The median length of stay was 7 days. The overall complication rate was 31% (N = 24), with 21% considered major and 7% considered life-threatening or fatal. Blood loss was significantly associated with postoperative complications (OR = 1.002; P = 0.02) and mortality (HR = 1.0007; P = 0.04). Significant associations of increased risk of death were also noted with surgeries with decompression, and cervical/cervicothoracic index level of disease. For deceased patients, median time to death was 4.5 months. For living patients, median follow-up was 14.5 months. The Kaplan-Meier based median overall survival for the cohort was 11.6 months (95% CI: 6.2-19.1). Conclusions: In octogenarians undergoing surgery with instrumentation for spinal metastases, the median overall survival is 11.6 months. There is an increased complication rate, but only 7% are life-threatening or fatal. Patients are at increased risk for complications and mortality particularly when performing decompression with stabilization, with increasing intraoperative blood loss, and with cervical/cervicothoracic tumors. |
| Keywords: | mortality; morbidity; spine; tumor; elderly; outcomes; lung-cancer; spinal metastasis; elderly-patients; invasive surgery; readmission; separation surgery; modified frailty index; octogenarian; percutaneous stabilization; medical complications; deformity surgery |
| Journal Title: | Global Spine Journal |
| Volume: | 13 |
| Issue: | 6 |
| ISSN: | 2192-5682 |
| Publisher: | Georg Thieme Verlag |
| Date Published: | 2023-07-01 |
| Start Page: | 1481 |
| End Page: | 1489 |
| Language: | English |
| ACCESSION: | WOS:000710577600001 |
| DOI: | 10.1177/21925682211037936 |
| PROVIDER: | wos |
| PMCID: | PMC10448094 |
| PUBMED: | 34670413 |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Ori Barzilai -- Source: Wos |
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