Delayed presentation to a spine surgeon is the strongest predictor of poor postoperative outcome in patients surgically treated for symptomatic spinal metastases

Tol, Floris R van; Choi, David; Verkooijen, Helena M.; Öner, F. Cumhur; Verlaan, Jorrit‐Jan

doi:10.1016/j.spinee.2019.04.011

Cited by 18 publications

(22 citation statements)

References 36 publications

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“…We previously reported on delayed surgical treatment of patients with spinal metastases being associated with worse surgical and postoperative outcomes, showing increased surgical duration, blood loss, length of stay (LOS) and postoperative adverse events [11]. The effects of delayed treatment on functional status, perceived quality of life and survival however remains largely unclear.…”

Section: Introductionmentioning

confidence: 99%

The importance of timely treatment for quality of life and survival in patients with symptomatic spinal metastases

et al. 2020

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Purpose A major challenge in metastatic spinal disease is timely identification of patients. Left untreated, spinal metastases may lead to gross mechanical instability and/or neurological deficits, often requiring extensive invasive surgical treatment. The aim of this cohort study was to assess the correlation between delayed treatment of patients with spinal metastases and functional performance, quality of life and survival. Methods All patients surgically treated for metastatic spinal disease at a tertiary care facility were included for analysis. Patients who underwent elective surgery were considered as timely treated, whereas patients requiring emergency surgery were considered to be treated in a delayed fashion. EQ-5D scores, KPS scores and mortality rates were compared between the two groups. Results A total of 317 patients (215 timely treated, 102 delayed) had survivorship data available and 202 patients (147 timely treated, 55 delayed) had clinical data available. Multivariate analyses showed delayed treatment was associated with lower EQ-5D and KPS scores and higher mortality rates, independent of confounders such as baseline EQ-5D/KPS scores, neurological status, tumor prognosis and patient age. Conclusions The results from the present study show delayed treatment of patients with symptomatic spinal metastases has both direct and indirect adverse consequences for functional performance status, quality of life and survival. Optimization of referral pattern may accelerate the time to surgical treatment, potentially leading to better quality of life and survival.

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Section: Introductionmentioning

confidence: 99%

The importance of timely treatment for quality of life and survival in patients with symptomatic spinal metastases

et al. 2020

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“…DL is already being used in spine diseases to aid in the diagnosis of spinal stenosis on MRI spines, surgical planning, and prediction of outcomes in patients with spinal metastases ( 8 , 29 ). DL in spinal oncology imaging is limited with most researchers focusing on the detection of metastases ( 30 ), or automated spinal cord segmentation as an organ at risk for radiotherapy planning ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

“…A deep learning (DL) model to automatically detect and classify low- versus high-grade Bilsky MESCC on MRI could alert the radiologist and clinical teams, ensuring prompt reporting and appropriate referral. This is important to prevent poor functional outcomes and increased requirements of healthcare resources ( 8 ). Automated tools for detecting urgent findings on MRI are important due to increasing demand for the modality, while faced with a shortage of radiologists ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Deep Learning Model for Classifying Metastatic Epidural Spinal Cord Compression on MRI

et al. 2022

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BackgroundMetastatic epidural spinal cord compression (MESCC) is a devastating complication of advanced cancer. A deep learning (DL) model for automated MESCC classification on MRI could aid earlier diagnosis and referral.PurposeTo develop a DL model for automated classification of MESCC on MRI.Materials and MethodsPatients with known MESCC diagnosed on MRI between September 2007 and September 2017 were eligible. MRI studies with instrumentation, suboptimal image quality, and non-thoracic regions were excluded. Axial T2-weighted images were utilized. The internal dataset split was 82% and 18% for training/validation and test sets, respectively. External testing was also performed. Internal training/validation data were labeled using the Bilsky MESCC classification by a musculoskeletal radiologist (10-year experience) and a neuroradiologist (5-year experience). These labels were used to train a DL model utilizing a prototypical convolutional neural network. Internal and external test sets were labeled by the musculoskeletal radiologist as the reference standard. For assessment of DL model performance and interobserver variability, test sets were labeled independently by the neuroradiologist (5-year experience), a spine surgeon (5-year experience), and a radiation oncologist (11-year experience). Inter-rater agreement (Gwet’s kappa) and sensitivity/specificity were calculated.ResultsOverall, 215 MRI spine studies were analyzed [164 patients, mean age = 62 ± 12(SD)] with 177 (82%) for training/validation and 38 (18%) for internal testing. For internal testing, the DL model and specialists all showed almost perfect agreement (kappas = 0.92–0.98, p < 0.001) for dichotomous Bilsky classification (low versus high grade) compared to the reference standard. Similar performance was seen for external testing on a set of 32 MRI spines with the DL model and specialists all showing almost perfect agreement (kappas = 0.94–0.95, p < 0.001) compared to the reference standard.ConclusionA DL model showed comparable agreement to a subspecialist radiologist and clinical specialists for the classification of malignant epidural spinal cord compression and could optimize earlier diagnosis and surgical referral.

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“…In accordance with previous studies reporting on unfavorable surgical outcomes and lower Quality of Life (QOL), functional status and survival, the need to prevent delayed surgical treatment is further emphasized. 13,14,24,25 By investing in a catchment area's referral chain, for instance by introducing a "hotline" or a multidisciplinary treatment system, the proportion of patients undergoing delayed treatment may decrease, thereby reducing the in-hospital and aftercare costs. 26,27 In the current study, the pre-clinical costs were higher (albeit non-significant) for timely treated patients, strengthening the idea that a relatively limited investment at the beginning of the referral chain will lead to considerably lower in-hospital and aftercare costs.…”

Section: Discussionmentioning

confidence: 99%

“…6,[8][9][10][11][12] It is well studied that emergency surgery leads to considerably worse patient outcome compared with timely interventions. 13,14 The optimization of referral patterns for patients with spinal metastases may reduce overall delay, preventing the negative effects associated with delayed treatment. A subsequent potential cost increase of more extensive diagnostics and referrals may, however, discourage health-care providers and insurance companies in pursuing this practice.…”

Section: Introductionmentioning

confidence: 99%

Costs Associated With Timely and Delayed Surgical Treatment of Spinal Metastases

Tol

Massier

Frederix

et al. 2021

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Symptoms caused by spinal metastases are often difficult to distinguish from symptoms caused by non-malignant spinal disease, complicating timely diagnosis, referral and treatment. The ensuing delays may promote the risk of neurological deficits or severe mechanical instability and consequent emergency surgery, leading to poorer prognosis. Presumably, treatment delay may subsequently lead to more health-care consumption and therefore increased average costs of treatment. Methods: All patients surgically treated for spinal metastases were included in the current study. Based on the presence of alarming symptoms and urgency of the required intervention, patients were categorized as having received timely or delayed treatment. Pre-surgical, in-hospital, aftercare and total costs were analyzed and compared between the 2 groups. Results: In total, 299 patients were included, of which 205 underwent timely and 94 delayed treatment. There was no significant difference in pre-surigcal costs (€3.229,13 in the timely treated group vs. €2.528,70 in the delayed treatment group, p = 0.849). The in-hospital costs (€16.738,49 vs. €13.108,81, p < 0.001) and the aftercare costs (€13.950,37 vs. 3.981,93, p < 0.001) were significantly higher for delayed treatment vs. timely treatment, respectively. The total costs were €33.741,71 for delayed treatment and €20.318,52 for timely treatment (p < 0.001). Conclusions: The total costs for timely treated patients with spinal metastases are significantly lower compared with patients receiving delayed treatment. Investing in the optimization of referral patterns may therefore reduce the overall pretreatment delay and subsequently increase patient outcome, leading to better clinical outcomes at lower costs.

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Delayed presentation to a spine surgeon is the strongest predictor of poor postoperative outcome in patients surgically treated for symptomatic spinal metastases

Cited by 18 publications

References 36 publications

The importance of timely treatment for quality of life and survival in patients with symptomatic spinal metastases

The importance of timely treatment for quality of life and survival in patients with symptomatic spinal metastases

Deep Learning Model for Classifying Metastatic Epidural Spinal Cord Compression on MRI

Costs Associated With Timely and Delayed Surgical Treatment of Spinal Metastases

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