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.
Study Design:
Prospective multicenter study.
Objective:
To investigate risk factors for 3-month postoperative mortality in metastatic spinal tumor surgery, focusing on nutritional biomarkers and prognostic scores alongside clinical indicators.
Summary Of Background Data:
Metastatic spinal tumors affect patient morbidity and mortality. Although prognostic tools exist, they have limitations, particularly in emergency situations requiring rapid assessment. Nutritional biomarkers and prognostic scores may influence outcomes, but their role in predicting early postoperative mortality after spinal tumor surgery, particularly in prospective, multicenter studies, warrants investigation.
Materials And Methods:
Data from 336 patients undergoing palliative surgery for metastatic spinal tumors were collected from 35 centers. The primary outcome was three-month postoperative mortality. Univariate and multivariate logistic regression analyses with bootstrapping were performed to identify predictors of early mortality, including demographics, prognostic scores [revised Tokuhashi, Tomita, modified Glasgow Prognostic Score (mGPS), and the New England Spinal Metastasis Score (NESMS)], and nutritional biomarkers. The discriminative ability of these factors was evaluated using the receiver operating characteristic curve analysis.
Results:
The three-month postoperative mortality rate was 15.5%, with primary cancer progression accounting for 54% of the deaths. Multivariate analysis revealed that high mGPS (OR=1.989, P =0.008) and low preoperative performance status (PS) (OR=1.412, P =0.034) were significant independent predictors of early mortality, the Tomita score showed a trend toward significance (OR=1.234, P =0.050). The mGPS demonstrated a high discriminative ability, with an area under the curve of 0.716.
Conclusion:
High mGPS and low preoperative PS are significant predictors of three-month postoperative mortality in patients undergoing surgery for metastatic spinal tumors. Incorporating the mGPS, which reflects nutritional and inflammatory status, into preoperative risk stratification is crucial for optimizing surgical decision-making.
Level Of Evidence:
Level II.
