Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
World Neurosurg. 2023 Oct;178:e549-e558. doi: 10.1016/j.wneu.2023.07.118. Epub 2023 Aug 1.
In patients undergoing surgery for spinal metastasis, we sought to: (1) describe patterns of palliative care consultation, (2) evaluate the factors that trigger palliative care consultation, and (3) determine the association of palliative care consultation on longer-term outcomes.
A single-center, retrospective, case-control study was conducted for patients undergoing spinal metastasis surgery from February 2010 to January 2021. The primary outcome was receiving a palliative care consultation, and the timing of consultation was divided into same hospital stay consultation, preoperative versus postoperative consultation, and early (<Postoperative day 7) versus late (≥Postoperative day 7) consultation.
Of 363 patients undergoing surgery for spinal metastasis, 62 (17.0%) patients received palliative care consultation during the same hospitalization, 11 (17.7%) were preoperative, and 51 (82.2%) were postoperative. Among same-stay consultations, 32 (51.6%) were early and 30 (48.4%) were late. Palliative care consultation recipients had worse preoperative Karnofsky Performance Scale (KPS) score (P < 0.001), were more likely to have other organ metastases (P = 0.005) or cord compression (P = 0.026), had longer hospitalization (P < 0.001), and were less likely to be discharged home (P < 0.001). Patients presenting with mechanical pain were more likely to receive preoperative consults compared with postoperative (P = 0.029), and earlier compared with later consultations (P = 0.046). Regarding long-term outcomes, patients with same-stay palliative care consultation had significantly shorter overall survival (log-rank; P < 0.001), worse KPS postoperatively (P = 0.017), and worse KPS and Modified McCormick Scale at the last follow-up (P < 0.001).
Only 1 in 6 patients received palliative care consultation. Patients receiving same-stay palliative care consultation had more advanced local and systemic disease burden. Increased utilization of palliative care consultation in patients with spine metastasis is needed.
在接受脊柱转移瘤手术的患者中，我们旨在：（1）描述姑息治疗咨询的模式；（2）评估触发姑息治疗咨询的因素；（3）确定姑息治疗咨询与长期预后的关系。
回顾性病例对照研究，纳入 2010 年 2 月至 2021 年 1 月期间在我院接受脊柱转移瘤手术的患者。主要结局是接受姑息治疗咨询，咨询时间分为同次住院咨询、术前与术后咨询以及早期（术后第 7 天内）与晚期（术后第 7 天以上）咨询。
363 例脊柱转移瘤手术患者中，62 例（17.0%）患者在同次住院期间接受了姑息治疗咨询，11 例（17.7%）为术前咨询，51 例（82.2%）为术后咨询。在同次住院咨询中，32 例（51.6%）为早期咨询，30 例（48.4%）为晚期咨询。姑息治疗咨询组患者术前 Karnofsky 表现状态评分（KPS）更差（P<0.001），更有可能存在其他器官转移（P=0.005）或脊髓压迫（P=0.026），住院时间更长（P<0.001），更不可能出院回家（P<0.001）。与术后咨询相比，机械性疼痛患者更有可能接受术前咨询（P=0.029），且更倾向于早期咨询（P=0.046）。关于长期预后，接受同次住院姑息治疗咨询的患者总生存时间明显缩短（对数秩检验；P<0.001），术后 KPS 更差（P=0.017），末次随访时 KPS 和改良 McCormick 分级更差（P<0.001）。
仅有 1/6 的患者接受了姑息治疗咨询。接受同次住院姑息治疗咨询的患者具有更严重的局部和全身疾病负担。需要增加脊柱转移瘤患者姑息治疗咨询的利用率。
