Risk factors for Early (Three-Month) Postoperative Mortality in Metastatic Spine Tumor Surgery: A JASA Multicenter
Takaaki Uto1, Satoshi Kato1, Noriaki Yokogawa1
1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
Spine
|April 15, 2025
Summary
High modified Glasgow Prognostic Score (mGPS) and low preoperative performance status predict 3-month mortality after metastatic spinal tumor surgery. This aids in better surgical risk assessment for these patients.
Area of Science:
- Oncology
- Neurosurgery
- Clinical Epidemiology
Background:
- Metastatic spinal tumors significantly impact patient morbidity and mortality.
- Existing prognostic tools for spinal tumor surgery have limitations, especially in emergency settings.
- The role of nutritional biomarkers and prognostic scores in predicting early mortality after surgery for metastatic spinal tumors requires further investigation.
Purpose of the Study:
- To identify risk factors for 3-month postoperative mortality in patients undergoing surgery for metastatic spinal tumors.
- To evaluate the predictive value of nutritional biomarkers and prognostic scores, including the modified Glasgow Prognostic Score (mGPS), alongside clinical indicators.
- To improve preoperative risk stratification for surgical decision-making.
Main Methods:
- A prospective multicenter study involving 336 patients undergoing palliative surgery for metastatic spinal tumors.
- Data collection included demographics, prognostic scores (Tomita, mGPS, NESMS), and nutritional biomarkers.
- Univariate and multivariate logistic regression analyses with bootstrapping were used to identify predictors of 3-month postoperative mortality.
Main Results:
- The 3-month postoperative mortality rate was 15.5%, with cancer progression being the leading cause.
- High mGPS (OR=1.989) and low preoperative performance status (PS) (OR=1.412) were identified as significant independent predictors of early mortality.
- The mGPS demonstrated strong discriminative ability (AUC=0.716) in predicting mortality.
Conclusions:
- High mGPS and low preoperative PS are crucial predictors of 3-month postoperative mortality in metastatic spinal tumor surgery.
- The mGPS, reflecting nutritional and inflammatory status, should be incorporated into preoperative risk assessment.
- Optimizing surgical decision-making for these patients can be enhanced by utilizing these predictive factors.
Keywords:
early postoperative mortalityinflammationmetastatic spinal tumorsmodified glasgow prognostic scorenutritional biomarkersperformance statuspreoperative assessmentprognostic nutritional indexrisk stratificationtomita score
