Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Ann Surg Oncol. 2021 May;28(5):2474-2482. doi: 10.1245/s10434-020-09404-7. Epub 2021 Jan 3.
Outcomes commonly used to ascertain success of metastatic spine tumour surgery (MSTS) are 30-day complications/mortality and overall/disease-free survival. We believe a new, effective outcome indicator after MSTS would be the absence of unplanned hospital readmission (UHR) after index discharge. We introduce the concept of readmission-free survival (ReAFS), defined as 'the time duration between hospital discharge after index operation and first UHR or death'. The aim of this study is to identify factors influencing ReAFS in MSTS patients.
We retrospectively analysed 266 consecutive patients who underwent MSTS between 2005 and 2016. Demographics, oncological characteristics, procedural, preoperative and postoperative details were collected. ReAFS of patients within 2 years or until death was reviewed. Perioperative factors predictive of reduced ReAFS were evaluated using multivariate regression analysis.
Of 266 patients, 230 met criteria for analysis. A total of 201 had UHR, whilst 1 in 8 (29/230) had no UHR. Multivariate analysis revealed that haemoglobin ≥ 12 g/dL, ECOG score of ≤ 2, primary prostate, breast and haematological cancers, comorbidities ≤ 3, absence of preoperative radiotherapy and shorter postoperative length of stay significantly prolonged the time to first UHR.
Readmission-free survival is a novel concept in MSTS, which relies on patients' general condition, appropriateness of interventional procedures and underlying disease burden. Additionally, it may indicate the successful combination of a multi-disciplinary treatment approach. This information will allow oncologists and surgeons to identify patients who may benefit from increased surveillance following discharge to increase ReAFS. We envisage that ReAFS is a concept that can be extended to other surgical oncological fields.
常用于确定转移性脊柱肿瘤手术（MSTS）成功的结果是 30 天并发症/死亡率和总生存率/无病生存率。我们认为，MSTS 后一个新的、有效的结果指标将是索引出院后无计划的医院再入院（UHR）。我们引入了无再入院生存率（ReAFS）的概念，定义为“从索引手术后出院到第一次 UHR 或死亡的时间间隔”。本研究的目的是确定影响 MSTS 患者 ReAFS 的因素。
我们回顾性分析了 2005 年至 2016 年间接受 MSTS 的 266 例连续患者。收集了人口统计学、肿瘤学特征、手术过程、术前和术后细节。回顾了 2 年内或直至死亡的患者的 ReAFS。使用多变量回归分析评估了与降低 ReAFS 相关的围手术期因素。
在 266 例患者中，230 例符合分析标准。共有 201 例发生 UHR，而 8 例中有 1 例（29/230）无 UHR。多变量分析显示，血红蛋白≥12 g/dL、ECOG 评分≤2、原发性前列腺癌、乳腺癌和血液系统癌症、合并症≤3、无术前放疗和较短的术后住院时间显著延长首次 UHR 的时间。
无再入院生存率是 MSTS 的一个新概念，它依赖于患者的一般状况、介入治疗的适当性和潜在的疾病负担。此外，它可能表明多学科治疗方法的成功结合。这些信息将使肿瘤学家和外科医生能够识别可能受益于增加出院后监测以提高 ReAFS 的患者。我们设想 ReAFS 是一个可以扩展到其他外科肿瘤学领域的概念。
