Elective Surgical Care Pathways Are Associated With Lower Fracture Rates at Presentation and Contribute to Superior...

Metastatic bone disease (MBD) often necessitates orthopaedic surgical intervention, which occurs through either emergent or elective care pathways. This study compared post-operative outcomes between patients undergoing elective versus emergent surgery for MBD involving the pelvis and appendicular skeleton.

We performed a retrospective, multicenter, propensity-matched cohort study of patients who underwent surgery for MBD. Emergent surgery was defined as an unplanned admission followed by unscheduled surgery, while elective surgery referred to cases with an outpatient orthopaedic consultation and scheduled procedure. Primary outcomes were overall survival (OS) from the time of surgery, hospital length of stay (LOS), and 30-day readmission.

Following propensity matching, 296 patients were included with 148 in each group. OS was significantly shorter in the emergent group (5.0 months 95%CI: 3.0-6.0 vs. 16.9 months 95%CI: 11.1-21.2) [p < 0.001]. LOS was significantly longer in the emergent group (13 days, 95%CI: 6-28 vs. 6 days, 95%CI: 3-10 days) [p < 0.001]. There was a significantly greater rate of readmission in the emergent group (12.2% 95%CI: 10.3-17.6 vs. 6.1% 95%CI: 3.5-10.2) [p = 0.004].

Elective surgery for MBD was associated with significantly superior clinical outcomes. Interventions that reduce the need for emergent surgery could markedly improve outcomes in this population.