Floris R van Tol1, David Choi2, Helena M Verkooijen3, F Cumhur Oner4, Jorrit-Jan Verlaan4. 1. Department of Orthopedic Surgery, University Medical Center Utrecht, the Netherlands. Electronic address: f.r.vantol@umcutrecht.nl. 2. Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK. 3. Imaging Division, University Medical Center Utrecht, the Netherlands; University of Utrecht, the Netherlands. 4. Department of Orthopedic Surgery, University Medical Center Utrecht, the Netherlands.
Abstract
BACKGROUND CONTEXT: Symptoms associated with spinal metastases are often nonspecific and resemble noncancer-related symptoms. Therefore, patients with spinal metastases are at risk for delayed referral and treatment. Delayed presentation of symptomatic spinal metastases may lead to the development of neurological deficits, often followed by emergency surgery. PURPOSE: The aim of this cohort study was to analyze the effect of delayed referral and treatment of spinal metastases on clinical outcome. METHODS: We included all patients surgically treated for spinal metastases at our tertiary care center. Based on the (in)ability to undergo elective surgery, patients were identified as timely treated or delayed. Patient- and tumor-characteristics, surgical variables, and postoperative variables such as complication rate, the ability to return home and length of hospital stay were recorded and compared between the two groups. RESULTS: Based on the urgency of treatment at admission, 206 patients were identified as timely treated and 98 as delayed. At baseline, the two groups did not differ significantly except for the extent of neurological symptoms. Timely treated patients underwent less invasive procedures (52.9% vs 13.3% percutaneous pedicle screw fixations), had less median blood loss (200cc vs 450cc), shorter median admission time (7 vs 13 days), lower complication rate (26.2% vs 48.0%) and higher chances of being discharged home immediately (82.6% vs 41.1%) compared with delayed patients. Using multivariate regression models these correlations remained present independent of tumor prognosis, preoperative mobility, and American Society of Anesthesiologists-score. CONCLUSIONS: The delayed presentation of patients with spinal metastases to a spinal surgeon is strongly and independently associated with worse surgical and postoperative outcome parameters. Improvements in referral patterns could potentially lead to more scheduled care, negating the detrimental effects of delay. Crown
BACKGROUND CONTEXT: Symptoms associated with spinal metastases are often nonspecific and resemble noncancer-related symptoms. Therefore, patients with spinal metastases are at risk for delayed referral and treatment. Delayed presentation of symptomatic spinal metastases may lead to the development of neurological deficits, often followed by emergency surgery. PURPOSE: The aim of this cohort study was to analyze the effect of delayed referral and treatment of spinal metastases on clinical outcome. METHODS: We included all patients surgically treated for spinal metastases at our tertiary care center. Based on the (in)ability to undergo elective surgery, patients were identified as timely treated or delayed. Patient- and tumor-characteristics, surgical variables, and postoperative variables such as complication rate, the ability to return home and length of hospital stay were recorded and compared between the two groups. RESULTS: Based on the urgency of treatment at admission, 206 patients were identified as timely treated and 98 as delayed. At baseline, the two groups did not differ significantly except for the extent of neurological symptoms. Timely treated patients underwent less invasive procedures (52.9% vs 13.3% percutaneous pedicle screw fixations), had less median blood loss (200cc vs 450cc), shorter median admission time (7 vs 13 days), lower complication rate (26.2% vs 48.0%) and higher chances of being discharged home immediately (82.6% vs 41.1%) compared with delayed patients. Using multivariate regression models these correlations remained present independent of tumor prognosis, preoperative mobility, and American Society of Anesthesiologists-score. CONCLUSIONS: The delayed presentation of patients with spinal metastases to a spinal surgeon is strongly and independently associated with worse surgical and postoperative outcome parameters. Improvements in referral patterns could potentially lead to more scheduled care, negating the detrimental effects of delay. Crown