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An International Delphi Consensus on Defining the Optimal Surgical Composite Outcome in Metastatic Spine Disease
Rafael De la Garza Ramos1, C Rory Goodwin2, Michael H Weber3
1Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY.
Study Design:
Delphi consensus.
Objective:
To define an optimal surgical composite outcome measure in patients with metastatic spine disease (OSCO-M) through international consensus among key opinion leaders.
Materials And Methods:
Members of the AO Spine Knowledge Forum Tumor, an international group of dedicated spine oncology surgeons and oncologists, participated in a modified Delphi process between March 2023 and November 2024. The study was conducted in 2 parts. The first part aimed on identifying which outcome variables were deemed important to be included in the composite outcome. The second part focused on the definition of a successful outcome with regards to the agreed variables from Part 1. Each part consisted of a questionnaire and a consensus meeting. Consensus was achieved when a threshold of 70% agreement was reached.
Results:
A total of 42 dedicated spine oncology surgeons and oncologists from North America, Latin America, Europe, and Asia participated. Over 87% of respondents agreed that composite measures reflect the multidimensional aspect of the surgical process more than an individual outcome variable. Most respondents (93%) agreed/strongly agreed that composite measures should be used to assess the quality of surgical care in spine oncology. Through consensus, the following three outcome variables were selected to define the OSCO-M: the absence of SAVES-V2 (Spinal Adverse Events Severity System, Version 2) grade 3 adverse events or higher within 30 days of surgery, maintaining or improving ECOG (Eastern Cooperative Oncology Group) performance status at 90 days, and being ambulatory (with or without aid) at 90 days.
Conclusion:
This is the first study defining a composite outcome measure in oncologic surgery for spinal metastases derived from an international group of key opinion leaders in spine oncology. The OSCO-M may be useful for future research in spine tumor patients and serve as a benchmark to optimize outcomes.
Insights
An international expert consensus defined the Optimal Surgical Composite Outcome Measure (OSCO-M) for spinal metastases. This new measure includes surgical safety, functional status, and mobility to improve patient care quality.
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.
