Aditya V Karhade1, Quirina C B S Thio1, Paul T Ogink1, Joseph H Schwab2. 1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. 2. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. jhschwab@mgh.harvard.edu.
Abstract
BACKGROUND: Elevated serum alkaline phosphatase has been previously studied as a biomarker for progression of metastatic disease and implicated in adverse skeletal events and worsened survival. The purpose of this study was to determine if serum alkaline phosphatase was a predictor of short-term mortality of patients undergoing surgery for spinal metastatic disease. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was queried for patients undergoing spinal surgery for metastatic disease. Bivariate and multivariable analyses was undertaken to determine the relationship between serum alkaline phosphatase and 30-day mortality. RESULTS: For the 1788 patients undergoing operative intervention for spinal metastatic disease between 2009 and 2016 the 30-day mortality was 8.49% (n = 151). In patients who survived beyond 30-days after surgery, n = 1627 (91.5%) the median [interquartile range] serum alkaline phosphatase levels were 126.4 [75-138], whereas in patients who had 30-day mortality, the serum alkaline phosphatase levels were 179.8 [114-187]. The optimal cut-off for alkaline phosphatase was determined to be 113 IU/L. On multivariable analysis, elevated serum alkaline phosphatase levels were associated with 30-day mortality (OR 1.61, 95% CI 1.12-2.32, p = 0.011). CONCLUSION: Elevated preoperative serum alkaline phosphatase is a marker for 30-day mortality in patients undergoing surgery for spinal metastatic disease. Future retrospective and prospective study designs should incorporate assessment of this serum biomarker to better understand the role for serum alkaline phosphatase in improving prognostication in spinal metastatic disease.
BACKGROUND: Elevated serum alkaline phosphatase has been previously studied as a biomarker for progression of metastatic disease and implicated in adverse skeletal events and worsened survival. The purpose of this study was to determine if serum alkaline phosphatase was a predictor of short-term mortality of patients undergoing surgery for spinal metastatic disease. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was queried for patients undergoing spinal surgery for metastatic disease. Bivariate and multivariable analyses was undertaken to determine the relationship between serum alkaline phosphatase and 30-day mortality. RESULTS: For the 1788 patients undergoing operative intervention for spinal metastatic disease between 2009 and 2016 the 30-day mortality was 8.49% (n = 151). In patients who survived beyond 30-days after surgery, n = 1627 (91.5%) the median [interquartile range] serum alkaline phosphatase levels were 126.4 [75-138], whereas in patients who had 30-day mortality, the serum alkaline phosphatase levels were 179.8 [114-187]. The optimal cut-off for alkaline phosphatase was determined to be 113 IU/L. On multivariable analysis, elevated serum alkaline phosphatase levels were associated with 30-day mortality (OR 1.61, 95% CI 1.12-2.32, p = 0.011). CONCLUSION: Elevated preoperative serum alkaline phosphatase is a marker for 30-day mortality in patients undergoing surgery for spinal metastatic disease. Future retrospective and prospective study designs should incorporate assessment of this serum biomarker to better understand the role for serum alkaline phosphatase in improving prognostication in spinal metastatic disease.
Authors: Janet E Brown; Richard J Cook; Allan Lipton; Luis Costa; Robert E Coleman Journal: Breast Cancer Res Treat Date: 2010-06-24 Impact factor: 4.872
Authors: C H Köhne; D Cunningham; F Di Costanzo; B Glimelius; G Blijham; E Aranda; W Scheithauer; P Rougier; M Palmer; J Wils; B Baron; F Pignatti; P Schöffski; S Micheel; H Hecker Journal: Ann Oncol Date: 2002-02 Impact factor: 32.976
Authors: Aditya V Karhade; Viren S Vasudeva; Hormuzdiyar H Dasenbrock; Yi Lu; William B Gormley; Michael W Groff; John H Chi; Timothy R Smith Journal: Neurosurg Focus Date: 2016-08 Impact factor: 4.047
Authors: Awais K Hussain; Khushdeep S Vig; Zoe B Cheung; Kevin Phan; Mauricio C Lima; Jun S Kim; Deepak A Kaji; Varun Arvind; Samuel Kang-Wook Cho Journal: Spine (Phila Pa 1976) Date: 2018-06-01 Impact factor: 3.468
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: PLoS Med Date: 2007-10-16 Impact factor: 11.069
Authors: Quirina C B S Thio; Aditya V Karhade; Emily Notman; Kevin A Raskin; Santiago A Lozano-Calderón; Marco L Ferrone; Jos A M Bramer; Joseph H Schwab Journal: J Orthop Date: 2020-08-17