Short-Term Outcomes in Planned Versus Unplanned Surgery for Spinal Metastases

Area of Science:

• Oncology
• Neurosurgery
• Surgical Outcomes Research

Background:

• Metastatic spine disease (MSD) is a common complication of advanced cancers, often requiring surgical intervention for pain, stability, and neurological preservation.
• While planned oncologic spine surgery is preferred, a significant number of patients undergo unplanned (urgent/emergent) procedures due to acute deterioration.
• The impact of surgical planning status on outcomes for MSD surgery is not well understood.

Purpose of the Study:

• To compare patient characteristics and short-term postoperative outcomes between planned and unplanned surgeries for spinal metastases.
• To identify factors influencing outcomes in patients undergoing surgery for metastatic spine disease.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2018-2023).
• Identified patients with disseminated cancer undergoing spinal tumor surgery, categorizing them into planned (elective) versus unplanned (urgent/emergent) groups.
• Primary endpoint: Failure to Rescue (FTR). Secondary endpoints: 30-day major complications, 30-day mortality, and length of hospital stay. Statistical analysis included univariable and multivariable regression.

Main Results:

• Of 2147 patients, 60% had planned and 40% had unplanned surgery.
• Unplanned surgery patients exhibited higher rates of severe hypoalbuminemia, severe anemia, and ASA class IV status (p ≤ 0.001).
• Multivariable analysis revealed unplanned surgery was significantly associated with increased FTR (OR 2.11, p=0.005), 30-day mortality (OR 1.84, p=0.002), and longer hospital stay (β 2.7, p<0.001), but not independently with 30-day major complications (p=0.08).

Conclusions:

• Unplanned surgery for metastatic spine disease is independently associated with significantly higher rates of failure to rescue, 30-day mortality, and extended hospital stay.
• These findings underscore the critical importance of timely identification and management of patients with MSD.
• Prioritizing semi-elective surgical care may improve outcomes for patients with spinal metastases.