Analysis of Short-Term versus Long-Term Readmission-Free Survival After Metastatic Spine Tumor Surgery

Madhu, Sirisha; Thomas, Allan; Tang, Sarah Shuyun; Shen, Liang; Ramakrishnan, Sridharan Alathur; Kumar, Naresh

doi:10.1016/j.wneu.2021.11.119

Cited by 7 publications

(4 citation statements)

References 45 publications

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“…36 Moreover, in a retrospective single-institution study of 350 adult patients undergoing surgery for vertebral column tumors, Ehresman et al found that higher mFI-5-de ned frailty risk was a signi cant predictor of non-routine discharge. 37 Regarding HFRS-de ned frailty risk, in the retrospective NIS database study of 11,480 patients undergoing surgery for metastatic spinal column tumors, Elsamadicy et al showed that intermediate (HFRS [5][6][7][8][9][10][11][12][13][14][15] and high (HFRS > 15) frailty risk each independently predicted extended LOS and non-routine discharge. 7 Similarly, in the retrospective NIS database study of 5,955 patients undergoing surgery for primary spinal or intradural cord tumors, Elsamadicy et al observed that increased HFRS-de ned frailty risk was signi cantly associated with extended LOS and non-routine discharge.…”

Section: Discussionmentioning

confidence: 99%

“…In the retrospective NRD database study of 1,974 patients with increased risk of frailty and 1,975 low-frailty-risk controls undergoing surgery for spinal metastases from 2016 to 2017, Bakhsheshian et al observed that patients with greater frailty risk had higher mean costs of admission and that increased risk of frailty was an independent predictor of increased costs. 36 Conversely, in the retrospective NIS database study of 11,480 patients undergoing surgery for metastatic spinal column tumors, Elsamadicy et al found that while mean total costs increased signi cantly along with increasing HFRS, intermediate (HFRS [5][6][7][8][9][10][11][12][13][14][15] and high (HFRS > 15) HFRS did not predict increased costs on multivariate analysis. 7 Similarly, in the retrospective NIS database study of 5,955 patients undergoing surgery for primary spinal or intradural cord tumors, Elsamadicy et al demonstrated that while patients with increased HFRS had higher mean costs, increased frailty risk did not signi cantly associate with increased costs on multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Elsamadicy

Koo

Reeves

et al. 2022

Preprint

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OBJECTIVE The Hospital Frailty Risk Score (HFRS) is a metric used to assess patient frailty risk in large national datasets using International Classification of Diseases, Tenth Revision (ICD-10) codes. While previous studies have assessed the association between frailty risk and postoperative outcomes in spine oncology, there is a paucity of data on the relationship between frailty risk and outcomes in patients undergoing surgery for spinal meningiomas. The goal of this study was to investigate the association between HFRS and hospital length of stay (LOS), discharge disposition, and cost of admission in patients undergoing surgery for spinal meningiomas. METHODS A retrospective cohort study was performed using the National Inpatient Sample Database from 2016 to 2019. Adult patients with benign or malignant spine meningiomas, identified using ICD-10 diagnostic and procedural coding, were stratified by HFRS: Low (HFRS < 5) and Intermediate-High (HFRS ≥ 5). These cohorts were further stratified by patient sex. Patient demographics, treating hospital characteristics, comorbidities, intraoperative variables, perioperative adverse events (AEs), LOS, discharge disposition, and cost of admission were assessed. Logistic multivariate regression analyses were performed to identify the associations between increased HFRS and LOS, discharge disposition, and cost in male and female patients. RESULTS Of the 3,345 study patients, 530 (15.8%) had Intermediate-High Frailty. Of the 530 Intermediate-High risk patients, 410 (77.4%) were female and of the 2,815 Low risk patients, 2,185 (77.6%) were female. The Intermediate-High cohort was significantly older (Low: 60.94±14.63 years vs Intermediate-High: 66.93±14.23 years, p < 0.001). A greater proportion of patients in the Intermediate-High cohort had three or more comorbidities (Low: 32.5% vs Intermediate-High: 74.5%, p < 0.001). Additionally, a greater proportion of patients in the Intermediate-High cohort experienced one or more perioperative AEs (Low: 7.1% vs Intermediate-High: 14.2, p = 0.018). Intermediate-High patients had longer mean LOS (Low: 4.02±2.30 days vs Intermediate-High: 7.14±6.03 days, p < 0.001) and higher mean total costs (Low: $24,344±$16,743 vs Intermediate-High: $37,013±$27,547, p < 0.001). Furthermore, a greater proportion of Intermediate-High patients had non-routine discharges (Low: 27.9% vs Intermediate-High: 55.7%, p < 0.001). On multivariate analysis, increased HFRS scores (≥ 5) were significantly associated with extended LOS (p < 0.001), non-routine discharge (p = 0.006), and increased costs (p = 0.004). CONCLUSION Our study shows that increased HFRS-defined frailty risk is significantly associated with extended LOS, non-routine discharge disposition, and increased costs in patients undergoing surgery for spine meningiomas. Further studies on the implications of frailty in these patients are merited in order to improve patient outcomes and healthcare resource utilization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Elsamadicy

Koo

Reeves

et al. 2022

Preprint

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“…While readmission likely does not directly impact patient's survival, it may be a downstream sign of functional decline and a proxy for postoperative morbidity. 31 Most studies exploring the impact of readmission on OS in cancer patients undergoing surgery draw from nonspine specialties, such as colorectal cancer, 32 esophageal cancer, 33 and ovarian cancer. 34 Readmission-free survival is a novel clinical metric that was developed by Kumar et al 35 in 266 patients undergoing spinal metastasis surgery, further highlighting the importance of avoiding readmissions to improve survival.…”

Section: Discussionmentioning

confidence: 99%

“…Unplanned readmission was associated with decreased OS. While readmission likely does not directly impact patient’s survival, it may be a downstream sign of functional decline and a proxy for postoperative morbidity 31. Most studies exploring the impact of readmission on OS in cancer patients undergoing surgery draw from nonspine specialties, such as colorectal cancer,32 esophageal cancer,33 and ovarian cancer 34.…”

Section: Discussionmentioning

confidence: 99%

Unplanned Readmission Is Associated With Decreased Overall Survival and Performance After Metastatic Spine Surgery

Chanbour

Chen

Gangavarapu

et al. 2023

Spine

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Study Design. Retrospective case-control study. Objective. In a cohort of patients undergoing metastatic spine surgery, we sought to: (1) identify risk factors associated with unplanned readmission, and (2) determine the impact of an unplanned readmission on long-term outcomes. Summary of Background Data. Factors affecting readmission after metastatic spine surgery remain relatively unexplored. Materials and Methods. A single-center, retrospective, case-control study was undertaken of patients undergoing spine surgery for extradural metastatic disease between 02/2010 and 01/2021. The primary outcome was 3-month unplanned readmission. Preoperative, perioperative, and tumor-specific variables were collected. Multivariable Cox regression was performed, controlling for tumor size, other organ metastasis, and preoperative/postoperative radiotherapy/chemotherapy. Results. A total of 357 patients underwent surgery for spinal metastases with a mean follow-up of 538.7±648.6 days. Unplanned readmission within 3 months of surgery occurred in 64/357 (21.9%) patients, 37 (57.8%) were medical, 27 (42.2%) surgical, and 21 (77.7%) were related to their spine surgery. No significant differences were found regarding demographics and preoperative variables, except for insurance, where most readmitted patients had private insurance compared with nonreadmitted patients (P=0.021). No significant difference was found in preoperative radiotherapy/chemotherapy. Regarding perioperative exposure variables, readmitted patients had a higher rate of postoperative complications (68.8% vs. 24.2%, P<0.001) and worse postoperative Karnofsky Performance Score (P=0.021) and Modified McCormick Scale (P=0.015) at the time of first follow-up. On multivariate logistic regression, postoperative complications were associated with increased readmissions (odds ratio=1.38, 95% CI=1.25–1.52, P<0.001). Regarding the impact of unplanned readmission on long-term tumor control, unplanned readmission was associated with shorter time to local recurrence (log-rank; P=0.029) and reduced overall survival (OS) (log-rank; P<0.001). On multivariate Cox regression, other organ metastasis [hazard ratio (HR)=1.48, 95% CI=1.13–1.93, P=0.004] and 3-month readmission (HR=1.75, 95% CI=1.28–2.39, P<0.001) were associated with worsened OS, with no impact on LR. Postoperative chemotherapy was significantly associated with longer OS (HR=0.59, 95% CI=0.45–0.77, P<0.001). Conclusions. Postoperative complications were associated with unplanned readmission following metastatic spine surgery. Furthermore, 3-month unplanned readmission was associated with a shorter time to local recurrence and decreased OS. These results help surgeons understand the drivers of readmissions and the impact of readmissions on patient outcomes. Level of Evidence. 3.

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Complication avoidance, rehabilitation, pain therapy and palliative care for patients with metastatic spine tumors: WFNS spine committee recommendations

Pojskic,

Naderi,

Vaishya

et al. 2024

Neurosurg Rev

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Objective: This review aims to formulate the most current, evidence-based recommendations regarding complication avoidance, rehabilitation, pain therapy and palliative care for patients with metastatic spine tumors. Methods: A systematic literature search in PubMed and MEDLINE, and was performed from 2013 to 2023 using the search terms “complications” + “spine metastases”, “spine metastases” + + “rehabilitation”, “spine metastases” + “pain therapy” + “palliative care”. Screening criteria resulted in 35, 15 and 56 studies respectively that were analyzed. Using the Delphi method and two rounds of voting at two separate international meetings, nine members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated nine final consensus statements. Results: Preoperative assessment for complications following surgery in patients with metastatic spine tumors should include estimation of Karnofsky score, site of primary tumor, number of spinal and visceral metastasis, ASA score and preoperative Hb (Hemoglobin) value. Complication risk factors are age > 65 years, preoperative ASA score of 3 and 4 and greater operative blood loss. Pain management using WHO analgesic concept and early mobilization are needed, starting with non-opioids, weak opioids followed by strong opioids. Morphine is the first choice for moderate to severe pain whereas IV-PCA may be used for severe breakthrough pain with monitoring. Use of bisphosphonates is considered in cases of non-localized pain and not accessible radiation therapy. Conclusions: These nine final consensus statements provide current, evidence-based guidelines on complication avoidance, rehabilitation, pain therapy and palliative care for patients with spinal metastases.

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Analysis of Short-Term versus Long-Term Readmission-Free Survival After Metastatic Spine Tumor Surgery

Cited by 7 publications

References 45 publications

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Association of Frailty Risk with Hospital Outcomes after Surgical Resection for Benign and Malignant Spinal Meningiomas

Unplanned Readmission Is Associated With Decreased Overall Survival and Performance After Metastatic Spine Surgery

Complication avoidance, rehabilitation, pain therapy and palliative care for patients with metastatic spine tumors: WFNS spine committee recommendations

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