Impact of complications on survival after surgery for metastatic spinal cord compression

Although complications are known to affect mortality in patients with spinal cord compression (MSCC), the impact of specific complication subtypes on survival and their risk factors remain poorly defined. The aim was to identify risk factors for perioperative and postoperative local and systemic complications in patients who underwent surgery for MSCC and to evaluate their association with postoperative survival.

We retrospectively analyzed 256 patients who underwent surgical treatment for MSCC between 2003 and 2022. Complications occurring within 30 days postoperatively were classified as perioperative, postoperative local, or postoperative systemic complications. Associations between complications and patient-related variables (age, comorbidities, smoking status, performance status, preoperative ambulatory status, and prior radiotherapy) and surgery-related variables (approach, intraoperative blood loss, and duration of surgery) were examined.

At least one complication occurred in 86 patients (33,6%): 14 perioperative, 39 systemic, and 33 local complications. Postoperative systemic complications (HR 1.8, 95% CI 1.2-2.5; p = 0.003) and lower performance status (HR 1.9, 95% CI 1.4-2.6; p < 0.001), were independently associated with reduced postoperative survival. Impaired preoperative ambulatory function was associated with postoperative complications (HR 2.1, 95% CI 1.0-4.3; p = 0.04).

Postoperative systemic complications were associated with reduced survival following surgery for MSCC. Impaired preoperative ambulatory function increases the risk of complications and should be emphasized in preoperative risk assessment and surgical decision-making.