Abstract：
OBJECTIVE: Determine whether perioperative outcomes differ between patients who have undergone single or multi-stage IMN procedures for impending or completed pathologic fractures.
METHODS: Patients were classified into single-stage single-bone (SSSB), single-stage multiple-bone (SSMB), and multi-stage multiple-bone (MSMB) based on procedure timing and number of bones involved. Outcome variables compared included length of stay (LOS), in-hospital mortality and survival, initiation of rehabilitation and adjuvant therapy, and perioperative complications.
RESULTS: There were 272 IMNs placed in 181 patients (100 males, 81 females, 55.2% and 44.8%, respectively) with a mean age of 66.3 ± 12.1 years. MSMB had significantly longer LOS (24.3 ± 14.2 days) and rehabilitation initiation (3.4 ± 2.5 days) compared to SSSB (8.5 ± 7.7 and 1.8 ± 1.6 days) and SSMB (11.5 ± 7.6 and 2.0 ± 1.6 days) subjects, respectively (both; p < 0.01). Although total perioperative complication rates in SSMB and MSMB were comparable (33.3% vs. 36.0%), they were significantly higher than SSSB (18%) (p = 0.038). MSMB had significantly more (20%) cardiopulmonary complications than SSMB (11.1%) and SSSB (4.5%) (p = 0.027). All groups exhibited comparative survivorship (8.1 ± 8.6, 7.1 ± 7.2, and 11.4 ± 11.8 months) and in-hospital mortality (4.5%, 8.9%, and 4.0%) (all; p > 0.05).
CONCLUSIONS: In comparison to MSMB, SSMB intramedullary nailing did not result in higher perioperative complication or in-hospital mortality rates in select patients with synchronous long-bone metastases but led to earlier postoperative discharge and initiation of rehabilitation.
METHODS: Patients were classified into single-stage single-bone (SSSB), single-stage multiple-bone (SSMB), and multi-stage multiple-bone (MSMB) based on procedure timing and number of bones involved. Outcome variables compared included length of stay (LOS), in-hospital mortality and survival, initiation of rehabilitation and adjuvant therapy, and perioperative complications.
RESULTS: There were 272 IMNs placed in 181 patients (100 males, 81 females, 55.2% and 44.8%, respectively) with a mean age of 66.3 ± 12.1 years. MSMB had significantly longer LOS (24.3 ± 14.2 days) and rehabilitation initiation (3.4 ± 2.5 days) compared to SSSB (8.5 ± 7.7 and 1.8 ± 1.6 days) and SSMB (11.5 ± 7.6 and 2.0 ± 1.6 days) subjects, respectively (both; p < 0.01). Although total perioperative complication rates in SSMB and MSMB were comparable (33.3% vs. 36.0%), they were significantly higher than SSSB (18%) (p = 0.038). MSMB had significantly more (20%) cardiopulmonary complications than SSMB (11.1%) and SSSB (4.5%) (p = 0.027). All groups exhibited comparative survivorship (8.1 ± 8.6, 7.1 ± 7.2, and 11.4 ± 11.8 months) and in-hospital mortality (4.5%, 8.9%, and 4.0%) (all; p > 0.05).
CONCLUSIONS: In comparison to MSMB, SSMB intramedullary nailing did not result in higher perioperative complication or in-hospital mortality rates in select patients with synchronous long-bone metastases but led to earlier postoperative discharge and initiation of rehabilitation.
摘要：
目的：确定因即将发生或完全的病理性骨折而接受单阶段或多阶段IMN手术的患者的围手术期结局是否不同。
方法：将患者分为单阶段单骨（SSSB），单级多骨（SSMB），和多阶段多骨（MSMB）基于手术时机和涉及的骨骼数量。比较的结果变量包括住院时间(LOS)，住院死亡率和生存率，开始康复和辅助治疗，围手术期并发症。
结果：181例患者中有272例IMN（100例男性，81名女性,55.2%和44.8%，分别），平均年龄为66.3±12.1岁。与SSSB（8.5±7.7和1.8±1.6天）和SSMB（11.5±7.6和2.0±1.6天）相比，MSMB的LOS（24.3±14.2天）和康复开始（3.4±2.5天）明显更长，分别(两者；p<0.01)。尽管SSMB和MSMB的围手术期总并发症发生率相当(33.3%vs.36.0%），它们显著高于SSSB(18%)(p=0.038)。MSMB的心肺并发症明显高于SSMB（11.1％）和SSSB（4.5％）（p=0.027）。所有组表现出比较生存率（8.1±8.6，7.1±7.2和11.4±11.8个月）和住院死亡率（4.5％，8.9%,和4.0%)(均；p>0.05)。
结论：与MSMB相比，SSMB髓内钉在选择的同步长骨转移患者中没有导致更高的围手术期并发症或院内死亡率，但导致术后更早的出院和开始康复。
方法：将患者分为单阶段单骨（SSSB），
结果：181例患者中有272例IMN（100例男性，
结论：与MSMB相比，
