An International Delphi Consensus on Defining the Optimal Surgical Composite Outcome in Metastatic Spine Disease

Area of Science:

• Oncology
• Neurosurgery
• Surgical Outcomes Research

Background:

• Metastatic spine disease presents complex challenges in surgical management.
• Existing outcome measures may not fully capture the multidimensional aspects of surgical care in this population.
• There is a need for a standardized, consensus-driven outcome measure for oncologic spinal surgery.

Purpose of the Study:

• To establish an optimal surgical composite outcome measure (OSCO-M) for patients with metastatic spine disease.
• To achieve international consensus among key opinion leaders in spine oncology on a composite outcome measure.
• To define critical variables for assessing surgical success in spinal oncology.

Main Methods:

• A modified Delphi process involving international spine oncology experts was employed.
• The study involved two parts: identifying important outcome variables and defining successful outcomes.
• Consensus was defined as a 70% agreement threshold reached through questionnaires and consensus meetings.

Main Results:

• Forty-two international experts in spine oncology participated in the consensus process.
• A strong agreement (over 87%) was found regarding the utility of composite measures over individual variables.
• The OSCO-M was defined by three key variables: absence of severe adverse events (SAVES-V2 Grade ≥3) within 30 days, maintained/improved ECOG performance status at 90 days, and ambulation at 90 days.

Conclusions:

• This study presents the first consensus-derived composite outcome measure for oncologic surgery of spinal metastases.
• The developed OSCO-M provides a novel benchmark for evaluating surgical quality in spine tumor patients.
• The OSCO-M is expected to facilitate future research and optimize patient outcomes in metastatic spine disease management.