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Post-operative complications affect survival in surgically treated metastatic spinal cord compression

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Abstract

Purpose

The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients.

Methods

Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan–Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups.

Results

Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174–365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence.

Conclusion

In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.

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Data Availability

The data that support the findings of this study are available from the corresponding author, [MC], upon reasonable request.

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Author information

Authors and Affiliations

  1. Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile

    Nicolás González-Kusjanovic, Byron Delgado Ochoa, Catalina Vidal & Mauricio Campos

Authors
  1. Nicolás González-Kusjanovic
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  2. Byron Delgado Ochoa
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  3. Catalina Vidal
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  4. Mauricio Campos
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nicolás González-Kusjanovic, Catalina Vidal, and Mauricio Campos. The first draft of the manuscript was written by Nicolás González-Kusjanovic and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mauricio Campos.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Pontificia Universidad Católica de Chile (ID approval number: 200625073).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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González-Kusjanovic, N., Delgado Ochoa, B., Vidal, C. et al. Post-operative complications affect survival in surgically treated metastatic spinal cord compression. International Orthopaedics (SICOT) 48, 1341–1350 (2024). https://doi.org/10.1007/s00264-024-06120-9

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