PDF(Pubmed)
Abstract：
UNASSIGNED: Accurate comparison of prophylactic surgical treatment (PST) to after fracture treatment (AF) of patients with femoral metastatic disease requires more accurately identifying patients for impending fracture, such as with CT-based structural rigidity analysis (CTRA). This study compares a more accurately defined PST group (of impending fractures defined by CTRA) to AF for metastatic femoral disease.
UNASSIGNED: PST patients were enrolled and treated by the PI in a longitudinal multicenter study of impending pathologic fractures evaluated for accuracy by CTRA. The AF patients were also treated by the senior author and were identified by retrospective chart review. Fifty-five patients were treated surgically for metastatic femoral lesions and were divided into three groups for the purpose of this study: Group I (AF), Group II (PST-high), and Group III (PST-low). Demographic information, comorbidities, and clinical variables of interest were collected by retrospective chart review; cost data was collected by collaboration with our hospital financial personnel (office of the Chief Financial Officer).
UNASSIGNED: Survival showed statistically significant differences favoring Group II. Transfusions in Group I were nearly twice those of Groups II and III, but there was no statistically significant (NS) difference between groups. Estimated blood loss (EBL) was generally with NS difference. Similarly, there were NS differences in LOS between groups. Discharge disposition showed statistically significant differences between groups (P=0.012, global). Discharge to home was highest in Group II (76%) and lowest in Group I (27%). Discharge to rehab was lowest in Group II (24%) and highest in Group I (47%). There were no discharges to hospice or morgue in Group II, while both occurred in Group I. Mean direct and total costs were highest in Group I ($18,837 and $31,997, respectively) and lowest in Group II ($16,094 and $27,357) but the differences were NS.
UNASSIGNED: This study shows benefits of PST over AF in a group of PST patients more accurately defined to have impending pathologic fractures by CTRA definition.
UNASSIGNED: PST patients were enrolled and treated by the PI in a longitudinal multicenter study of impending pathologic fractures evaluated for accuracy by CTRA. The AF patients were also treated by the senior author and were identified by retrospective chart review. Fifty-five patients were treated surgically for metastatic femoral lesions and were divided into three groups for the purpose of this study: Group I (AF), Group II (PST-high), and Group III (PST-low). Demographic information, comorbidities, and clinical variables of interest were collected by retrospective chart review; cost data was collected by collaboration with our hospital financial personnel (office of the Chief Financial Officer).
UNASSIGNED: Survival showed statistically significant differences favoring Group II. Transfusions in Group I were nearly twice those of Groups II and III, but there was no statistically significant (NS) difference between groups. Estimated blood loss (EBL) was generally with NS difference. Similarly, there were NS differences in LOS between groups. Discharge disposition showed statistically significant differences between groups (P=0.012, global). Discharge to home was highest in Group II (76%) and lowest in Group I (27%). Discharge to rehab was lowest in Group II (24%) and highest in Group I (47%). There were no discharges to hospice or morgue in Group II, while both occurred in Group I. Mean direct and total costs were highest in Group I ($18,837 and $31,997, respectively) and lowest in Group II ($16,094 and $27,357) but the differences were NS.
UNASSIGNED: This study shows benefits of PST over AF in a group of PST patients more accurately defined to have impending pathologic fractures by CTRA definition.
摘要：
■准确比较股骨转移性疾病患者的预防性手术治疗（PST）与骨折后治疗（AF）需要更准确地识别即将发生骨折的患者，例如基于CT的结构刚度分析(CTRA)。这项研究比较了更准确定义的PST组（由CTRA定义的即将发生的骨折）与转移性股骨疾病的AF。
■PST患者在一项纵向多中心研究中纳入并接受PI治疗，该研究通过CTRA评估即将发生的病理性骨折的准确性。房颤患者也由资深作者进行治疗，并通过回顾性图表审查进行鉴定。55例患者接受了手术治疗的转移性股骨病变，并为本研究的目的分为三组：I组（AF），II组（PST高），和第三组（PST低）。人口统计信息,合并症,和临床相关变量通过回顾性图表回顾收集;成本数据通过与我院财务人员(首席财务官办公室)合作收集.
■生存率显示出有利于II组的统计学显著差异。第一组的输血量几乎是第二组和第三组的两倍，但两组间差异无统计学意义(NS)。估计的失血量（EBL）通常与NS差异。同样，组间LOS有NS差异。出院处置在组间显示有统计学意义(P=0.012,全局)。出院率在第二组中最高（76％），在第一组中最低（27％）。第II组的出院率最低（24％），第I组的出院率最高（47％）。第二组没有出院到临终关怀或停尸房,而两者均发生在第一组中。第一组的平均直接和总成本最高（分别为18,837美元和31,997美元），第二组最低（16,094美元和27,357美元），但差异均为NS。
■本研究显示，在一组根据CTRA定义更准确定义为即将发生病理性骨折的PST患者中，PST优于AF。
■PST患者在一项纵向多中心研究中纳入并接受PI治疗，该研究通过CTRA评估即将发生的病理性骨折的准确性。房颤患者也由资深作者进行治疗，并通过回顾性图表审查进行鉴定。55例患者接受了手术治疗的转移性股骨病变，并为本研究的目的分为三组：I组（AF），II组（PST高），和第三组（PST低）。人口统计信息,合并症,和临床相关变量通过回顾性图表回顾收集;成本数据通过与我院财务人员(首席财务官办公室)合作收集.
■生存率显示出有利于II组的统计学显著差异。第一组的输血量几乎是第二组和第三组的两倍，但两组间差异无统计学意义(NS)。估计的失血量（EBL）通常与NS差异。同样，组间LOS有NS差异。出院处置在组间显示有统计学意义(P=0.012,全局)。出院率在第二组中最高（76％），在第一组中最低（27％）。第II组的出院率最低（24％），第I组的出院率最高（47％）。第二组没有出院到临终关怀或停尸房,而两者均发生在第一组中。第一组的平均直接和总成本最高（分别为18,837美元和31,997美元），第二组最低（16,094美元和27,357美元），但差异均为NS。
■本研究显示，在一组根据CTRA定义更准确定义为即将发生病理性骨折的PST患者中，PST优于AF。
