A Amelot1, L Balabaud2, D Choi3, Z Fox3, H A Crockard3, T Albert4, C M Arts5, J M Buchowski6, C Bunger7, C K Chung8, M H Coppes9, B Depreitere10, M G Fehlings11, J Harrop4, N Kawahara12, E S Kim13, C S Lee13, Y Leung14, Z J Liu15, J A Martin-Benlloch16, E M Massicotte11, B Meyer17, F C Oner18, W Peul19, N Quraishi20, Y Tokuhashi21, K Tomita22, C Ulbricht23, J J Verlaan18, M Wang24, C Mazel2. 1. Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France. Electronic address: aymmed@hotmail.fr. 2. Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France. 3. Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, University College London, London, UK. 4. Departments of Neurosurgery and Orthopedic Surgery, Thomas Jefferson University and Hospitals, Philadelphia, PA, USA. 5. Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, The Netherlands. 6. Departments of Orthopedic and Neurological Surgery, Washington University, MO, USA. 7. Department of Orthopedic Surgery, University Hospital of Aarhus, Aarhus, Denmark. 8. Department of Neurosurgery, Seoul National University, Seoul, South Korea. 9. Department of Neurosurgery, Groningen, The Netherlands. 10. Division of Neurosurgery, University Hospital Leuven, Leuven, Belgium. 11. Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada. 12. Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan. 13. Departments of Orthopedic Surgery and Neurosurgery, Samsung Medical Center, Seoul, South Korea. 14. Department of Orthopaedic Surgery, Musgrove Park Hospital, Taunton, UK. 15. Department of Orthopedics, Peking University Hospital, Beijing, China. 16. Spinal Unit, Hospital Universitario Dr Peset, Valencia, Spain. 17. Department of Neurosurgery, Technical University of Munich, Munich, Germany. 18. Department of Orthopedic Surgery, University Medical Center Utrecht, The Netherlands. 19. Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands. 20. Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, UK. 21. Department of Orthopaedic Surgery, Nihon University School of Medicine, Japan. 22. Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan. 23. Department of Neurosurgery, Charing Cross Hospital, London, UK. 24. Department of Neurosurgery, Jackson Memorial Hospital, University of Miami, Miami, FL, USA.
Abstract
BACKGROUND: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. PURPOSE: We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. STUDY DESIGN: We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. PATIENT SAMPLE: There were 1,266 patients recruited between March 2001 and October 2014. OUTCOME MEASURES: Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. METHODS: We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: <70, 70-80, and >80 years. RESULTS: Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients <70 years, p=.004). EQ-5D improved in all groups, but survival expectancy was significantly longer in patients <70 years old (p=.02). Furthermore, neurologic recovery after surgery was lower in patients >80 years old. CONCLUSIONS: Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.
BACKGROUND: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. PURPOSE: We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. STUDY DESIGN: We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. PATIENT SAMPLE: There were 1,266 patients recruited between March 2001 and October 2014. OUTCOME MEASURES: Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. METHODS: We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: <70, 70-80, and >80 years. RESULTS: Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients <70 years, p=.004). EQ-5D improved in all groups, but survival expectancy was significantly longer in patients <70 years old (p=.02). Furthermore, neurologic recovery after surgery was lower in patients >80 years old. CONCLUSIONS: Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.
Authors: Olivier Q Groot; Paul T Ogink; Nuno Rei Paulino Pereira; Marco L Ferrone; Mitchell B Harris; Santiago A Lozano-Calderon; Andrew J Schoenfeld; Joseph H Schwab Journal: Clin Orthop Relat Res Date: 2019-07 Impact factor: 4.176
Authors: Azeem Tariq Malik; Safdar N Khan; Ryan T Voskuil; John H Alexander; Joseph P Drain; Thomas J Scharschmidt Journal: Clin Orthop Relat Res Date: 2021-06-01 Impact factor: 4.755