Unplanned Readmission After Surgery for Cervical Spine Metastases

Hani Chanbour; Lakshmi Suryateja Gangavarapu; Jeffrey W Chen; Gabriel A Bendfeldt; Iyan Younus; Mahmoud Ahmed; Steven G Roth; Leo Y Luo; Silky Chotai; Amir M Abtahi; Byron F Stephens; Scott L Zuckerman

doi:10.1016/j.wneu.2022.12.106

Unplanned Readmission After Surgery for Cervical Spine Metastases

World Neurosurg. 2023 Mar:171:e768-e776. doi: 10.1016/j.wneu.2022.12.106. Epub 2022 Dec 27.

Affiliations

¹ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
³ Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: scott.zuckerman@vumc.org.

PMID: 36584895
DOI: 10.1016/j.wneu.2022.12.106

Abstract

Objective: Patients undergoing surgery for cervical spine metastases are at risk for unplanned readmission due to comorbidities and chemotherapy/radiation. Our objectives were to: 1) report the incidence of unplanned readmission, 2) identify risk factors associated with unplanned readmission, and 3) determine the impact of an unplanned readmission on long-term outcomes.

Methods: A single-center, retrospective, case-control study was undertaken of patients undergoing cervical spine surgery for metastatic disease between 02/2010 and 01/2021. The primary outcome of interest was unplanned readmission within 6 months. Survival analysis was performed for overall survival (OS) and local recurrence (LR).

Results: A total of 61 patients underwent cervical spine surgery for metastatic disease with the following approaches: 11 (18.0%) anterior, 28 (45.9%) posterior, and 22 (36.1%) combined. Mean age was 60.9 ± 11.2 years and 38 (62.3%) were males. A total of 9/61 (14.8%) patients had an unplanned readmission, 3 for surgical reasons and 6 for medical reasons. No difference was found in demographics, preoperative Karnofsky Performance Scale (P = 0.992), motor strength (P = 0.477), or comorbidities (P = 0.213) between readmitted patients versus not. Readmitted patients had a higher rate of preoperative radiation (P = 0.009). No statistical differences were found in operative time (P = 0.893), estimated blood loss (P = 0.676), length of stay (P = 0.720), discharge disposition (P = 0.279), and operative approach (P = 0.450). Furthermore, no difference was found regarding complications (P = 0.463), postoperative Karnofsky Performance Scale (P = 0.535), and postoperative Modified McCormick Scale (P = 0.586). Lastly, unplanned readmissions were not associated with OS (log-rank; P = 0.094) or LR (log-rank; P = 0.110).

Conclusions: In patients undergoing cervical spine metastasis surgery, readmission occurred in 15% of patients, 33% for surgical reasons, and 67% for medical reasons. Preoperative radiotherapy was associated with an increased rate of unplanned readmissions, yet readmission had no association with OS or LR.

Keywords: Cervical spine; Functional performance; Metastasis; Overall survival; Radiotherapy; Readmission.

MeSH terms

Aged
Carcinoma* / complications
Case-Control Studies
Cervical Vertebrae / surgery
Female
Humans
Male
Middle Aged
Patient Readmission
Postoperative Complications / epidemiology
Retrospective Studies
Risk Factors
Spine / surgery
Uterine Cervical Neoplasms*