Factors influencing early postoperative complications following surgery for symptomatic spinal metastasis: a single-center series and multivariate analysis
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Patients presenting with neurological deficits and/or pain due to spinal metastasis usually require immediate or subacute surgical treatment. Nevertheless, it is unclear whether or not side effects of primary cancer location might influence postoperative complication rate. We therefore analyzed our spinal database to identify factors influencing early postoperative complications after surgery for symptomatic spinal metastases. From 2013 to 2017, 163 consecutive patients suffering from symptomatic spinal metastases were treated at our department. Early postoperative complications were defined as any postoperative event requiring additional medical or surgical treatment within 30 days of spinal surgery. A multivariate regression analysis was performed to identify independent predictors for postoperative complications after surgery for spinal metastasis. Overall, 39 of 163 patients who underwent spinal surgery for spinal metastasis developed early postoperative complications throughout the treatment course (24%). Preoperative ASA score ≥ 3 (p = 0.003), preoperative C-reactive protein level > 10 mg/l (p = 0.008), preoperative Karnofsky Performance Score < 60% (p = 0.03), radiation treatment within 2 months of surgery (p = 0.01), presence of diabetes mellitus (p = 0.008), and preoperative complete neurological impairment (p = 0.04) were significant and independent predictors for early postoperative complications in patients with surgery for spinal metastasis. The ability to preoperatively predict postoperative complication risk is valuable to select critically ill patients at higher risk requiring special attention. Therefore, the present study identified several significant and independent risk factors for the development of early postoperative complication in patients who underwent surgery for spinal metastasis.
KeywordsSpinal metastasis Postoperative complication Spinal surgery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
The present study was approved by the local ethics committee of the University of Bonn (092/18).
Informed consent was not sought as a retrospective study design was used.
- 4.Carl HM, Ahmed AK, Abu-Bonsrah N, De la Garza Ramos R, Sankey EW, Pennington Z, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Sacks JM, Goodwin CR, Sciubba DM (2018) Risk factors for wound-related reoperations in patients with metastatic spine tumor. J Neurosurgery Spine 28(6):663–668CrossRefGoogle Scholar
- 5.Lau D, Leach MR, Than KD, Ziewacz J, La Marca F, Park P (2013) Independent predictors of complication following surgery for spinal metastasis. European Spine J : Official Publication European Spine Soc, European Spinal Deformity Soc, European Section Cervical Spine Res Soc 22(6):1402–1407CrossRefGoogle Scholar
- 6.Pereira NRP, Ogink PT, Groot OQ, Ferrone ML, Hornicek FJ, van Dijk CN, Bramer JAM, Schwab JH (2018) Complications and reoperations after surgery for 647 patients with spine metastatic disease. Spine JGoogle Scholar
- 8.Sailhan F, Prost S, Zairi F, Gille O, Pascal-Mousselard H, Bennis S, Charles YP, Blondel B, Fuentes S, French Spine S (2018) Retrospective multicenter study by the French Spine Society of surgical treatment for spinal metastasis in France. Orthop Traumatol Surg ResGoogle Scholar
- 11.Sebaaly A, Shedid D, Boubez G, Zairi F, Kanhonou M, Yuh SJ, Wang Z (2018) Surgical site infection in spinal metastasis: incidence and risk factors. Spine JGoogle Scholar
- 16.Shiozaki A, Fujiwara H, Okamura H, Murayama Y, Komatsu S, Kuriu Y, Ikoma H, Nakanishi M, Ichikawa D, Okamoto K, Ochiai T, Kokuba Y, Otsuji E (2012) Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett 3(4):907–912PubMedPubMedCentralGoogle Scholar
- 17.Fujiwara H, Suchi K, Okamura S, Okamura H, Umehara S, Todo M, Shiozaki A, Kubota T, Ichikawa D, Okamoto K, Ochiai T, Kokuba Y, Sonoyama T, Otsuji E (2011) Elevated serum CRP levels after induction chemoradiotherapy reflect poor treatment response in association with IL-6 in serum and local tumor site in patients with advanced esophageal cancer. J Surg Oncol 103(1):62–68CrossRefGoogle Scholar
- 18.Fu KM, Smith JS, Polly DW, Jr., Ames CP, Berven SH, Perra JH, McCarthy RE, Knapp DR, Jr., Shaffrey CI, Scoliosis Research Society M, Mortality C (2011) Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery. J Neurosurgery Spine 14 (4):470–474PubMedGoogle Scholar
- 20.Choi D, Fox Z, Albert T, Arts M, Balabaud L, Bunger C, Buchowski JM, Coppes MH, Depreitere B, Fehlings MG, Harrop J, Kawahara N, Martin-Benlloch JA, Massicotte EM, Mazel C, Oner FC, Peul W, Quraishi N, Tokuhashi Y, Tomita K, Verlaan JJ, Wang M, Crockard HA (2015) Prediction of quality of life and survival after surgery for symptomatic spinal metastases: a multicenter cohort study to determine suitability for surgical treatment. Neurosurgery 77(5):698–708 discussion 708CrossRefGoogle Scholar