Schoenfeld Andrew J, Leonard Dana A, Saadat Ehsan, Bono Christopher M, Harris Mitchel B, Ferrone Marco L
*Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts†Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Spine (Phila Pa 1976). 2016 Apr;41(8):E503-9. doi: 10.1097/BRS.0000000000001273.
A retrospective review.
We sought to use data from 4 tertiary medical centers to explore surgical, medical, and demographic factors that influence survival within the first 90 days following surgery for spinal metastases.
Over the last 2 decades, patients with spinal metastases have become more likely to receive surgical intervention. The impact of surgical intervention and its potential benefits must be weighed against the risk of complications and peri-operative mortality. Risk factors that elevate the risk of mortality in the acute postoperative period are not well understood.
All records of patients who underwent surgery for metastatic spinal disease at 1 of 4 academic medical centers in New England from 2007 to 2013 were obtained. Patient demographics, tumor characteristics, medical comorbidities, nutritional and functional status, as well as surgical variables were abstracted. Mortality was assessed for patients at 30 and 90 days following the procedure. Factors predictive of survival were assessed using bivariate logistic regression. Those factors with P values < 0.20 in the bivariate assessment were included in a final multivariable model that adjusted for confounders.
Between 2007 and 2013, 318 patients received surgical intervention for metastatic disease involving the spine. Cancer type did not influence the odds of survival at 30 days, while nutritional status and ambulatory capacity increased survival. Lung cancer significantly decreased the odds of survival at 90 days following surgery (odds ratio 0.36; 95% confidence interval 0.18-0.72), while ambulatory function and nutritional status remained significantly associated with improved survival.
This effort is one of the first to identify predictors of acute postoperative survival in a large series of patients treated for spinal metastases. Improved nutritional status and ambulatory function may enhance postoperative survival among individuals who undergo surgical intervention for spinal metastases.
一项回顾性研究。
我们试图利用来自4家三级医疗中心的数据，探讨影响脊柱转移瘤手术后90天内生存率的手术、医疗和人口统计学因素。
在过去20年中，脊柱转移瘤患者接受手术干预的可能性越来越大。手术干预的影响及其潜在益处必须与并发症风险和围手术期死亡率相权衡。术后急性期增加死亡风险的危险因素尚不清楚。
获取2007年至2013年在新英格兰4家学术医疗中心之一接受转移性脊柱疾病手术的患者的所有记录。提取患者的人口统计学信息、肿瘤特征、医疗合并症、营养和功能状态以及手术变量。对术后30天和90天的患者进行死亡率评估。使用二元逻辑回归评估生存的预测因素。在二元评估中P值<0.20的因素被纳入最终的多变量模型，该模型对混杂因素进行了调整。
2007年至2013年期间，318例患者接受了涉及脊柱的转移性疾病的手术干预。癌症类型不影响30天的生存几率，而营养状况和行走能力则提高了生存率。肺癌显著降低了手术后90天的生存几率（比值比0.36；95%置信区间0.18 - 0.72），而行走功能和营养状况仍然与生存率的提高显著相关。
这项研究是首批在大量接受脊柱转移瘤治疗的患者中确定术后急性生存预测因素的研究之一。改善营养状况和行走功能可能会提高接受脊柱转移瘤手术干预患者的术后生存率。
3级。
