PDF(Pubmed)
Abstract：
BACKGROUND: Approximately 20% of patients with metastatic spine disease develop symptomatic spinal cord compression, and these patients can present urgently to the emergency department (ED) or, in a more organized fashion, to a clinic. In a cohort of patients undergoing metastatic spine surgery, we sought to (1) determine the rate of ED presentation, (2) identify preoperative and perioperative risk factors associated with ED presentation, and (3) evaluate whether ED vs. clinic presentation impacts long-term outcomes.
METHODS: A single-institution, multi-surgeon, retrospective cohort study was undertaken of patients undergoing metastatic spinal tumor surgery between 02/2010 and 01/2021. The primary exposure variable was presentation setting, dichotomized to the ED vs. clinic. The primary outcomes were postoperative functional status, measured with the Karnofsky Performance Scale (KPS) and McCormick Scale (MMS), local recurrence (LR), and overall survival (OS). Secondary outcomes included complications and readmissions.
RESULTS: A total of 311 patients underwent metastatic spine surgery (51.7% ED vs. 48.3% clinic). Those presenting to the ED had higher rates of smoking (21.7% vs. 16.0%, p = 0.02), were more likely to have 2+ comorbidities (47.2% vs. 32.7%, p = 0.011), and were more likely to have public insurance (43.5% vs. 32.0%, p = 0.043). Preoperative KPS was lower in ED patients (p < 0.001), while the Bilsky score was higher (p = 0.049). ED patients had higher rates of oligometastatic disease (p = 0.049), higher total decompressed levels (p = 0.041), and higher rates of costotransversectomy (p = 0.031) compared to clinic patients. Length of stay was significantly longer for ED patients (7.7 ± 6.1 vs. 6.1 ± 5.8 days, p = 0.020), and they were less likely to be discharged home (52.2% vs. 69.3%, p = 0.025). ED presentation was significantly associated with shorter overall survival (HR =1.53 95% CI = 1.13-2.08, p = 0.006).
CONCLUSIONS: Of patients undergoing metastatic spine disease, approximately half presented through the ED vs. clinic. ED patients had higher rates of smoking, public insurance, and higher Bilsky score. ED patients also underwent more extensive surgery, had longer LOS, were less likely discharged home, and most importantly, had a shorter overall survival. These results suggest that initial presentation for patients undergoing surgery for metastatic spine disease significantly impacts outcomes, and signs/symptoms of metastatic spine disease should be recognized as soon as possible to prevent ED presentation.
METHODS: A single-institution, multi-surgeon, retrospective cohort study was undertaken of patients undergoing metastatic spinal tumor surgery between 02/2010 and 01/2021. The primary exposure variable was presentation setting, dichotomized to the ED vs. clinic. The primary outcomes were postoperative functional status, measured with the Karnofsky Performance Scale (KPS) and McCormick Scale (MMS), local recurrence (LR), and overall survival (OS). Secondary outcomes included complications and readmissions.
RESULTS: A total of 311 patients underwent metastatic spine surgery (51.7% ED vs. 48.3% clinic). Those presenting to the ED had higher rates of smoking (21.7% vs. 16.0%, p = 0.02), were more likely to have 2+ comorbidities (47.2% vs. 32.7%, p = 0.011), and were more likely to have public insurance (43.5% vs. 32.0%, p = 0.043). Preoperative KPS was lower in ED patients (p < 0.001), while the Bilsky score was higher (p = 0.049). ED patients had higher rates of oligometastatic disease (p = 0.049), higher total decompressed levels (p = 0.041), and higher rates of costotransversectomy (p = 0.031) compared to clinic patients. Length of stay was significantly longer for ED patients (7.7 ± 6.1 vs. 6.1 ± 5.8 days, p = 0.020), and they were less likely to be discharged home (52.2% vs. 69.3%, p = 0.025). ED presentation was significantly associated with shorter overall survival (HR =1.53 95% CI = 1.13-2.08, p = 0.006).
CONCLUSIONS: Of patients undergoing metastatic spine disease, approximately half presented through the ED vs. clinic. ED patients had higher rates of smoking, public insurance, and higher Bilsky score. ED patients also underwent more extensive surgery, had longer LOS, were less likely discharged home, and most importantly, had a shorter overall survival. These results suggest that initial presentation for patients undergoing surgery for metastatic spine disease significantly impacts outcomes, and signs/symptoms of metastatic spine disease should be recognized as soon as possible to prevent ED presentation.
摘要：
背景：大约20%的脊柱转移性疾病患者出现症状性脊髓压迫，这些患者可以紧急前往急诊科（ED）或，以更有组织的方式，去诊所.在接受脊柱转移性手术的患者队列中，我们试图(1)确定ED呈现率，(2)明确与ED表现相关的术前和围手术期危险因素,(3)评估ED是否与临床表现影响长期结果。
方法：单一机构，多外科医生，我们对2010年2月至2021年1月接受脊柱转移性肿瘤手术的患者进行了回顾性队列研究.主要的曝光变量是演示设置，分为ED与诊所。主要结果是术后功能状态，用Karnofsky绩效量表(KPS)和McCormick量表(MMS)测量，局部复发(LR)，总生存率（OS）。次要结果包括并发症和再入院。
结果：共有311例患者接受了脊柱转移性手术（51.7%EDvs.48.3%诊所）。向急诊室就诊的人吸烟率较高(21.7%与16.0%,p=0.02),更有可能有2+合并症(47.2%与32.7%,p=0.011),并且更有可能拥有公共保险(43.5%与32.0%,p=0.043)。ED患者术前KPS较低(p<0.001),而Bilsky评分较高（p=0.049）。ED患者的寡转移疾病发生率较高（p=0.049），较高的总减压水平(p=0.041)，与临床患者相比，肋段切除术的发生率更高（p=0.031）。ED患者的住院时间明显更长（7.7±6.1vs.6.1±5.8天,p=0.020),他们不太可能出院回家(52.2%vs.69.3%,p=0.025)。ED表现与总生存期缩短显著相关(HR=1.5395%CI=1.13-2.08,p=0.006)。
结论：在脊柱转移性疾病患者中，大约一半通过ED与诊所。ED患者吸烟率较高，公共保险,和更高的Bilsky分数.ED患者还接受了更广泛的手术，有更长的LOS，不太可能出院回家，最重要的是,总生存期较短。这些结果表明，接受转移性脊柱疾病手术的患者的初次就诊显着影响预后。应尽快识别脊柱转移性疾病的体征/症状，以防止ED出现。
方法：单一机构，多外科医生，我们对2010年2月至2021年1月接受脊柱转移性肿瘤手术的患者进行了回顾性队列研究.主要的曝光变量是演示设置，分为ED与诊所。主要结果是术后功能状态，用Karnofsky绩效量表(KPS)和McCormick量表(MMS)测量，局部复发(LR)，总生存率（OS）。次要结果包括并发症和再入院。
结果：共有311例患者接受了脊柱转移性手术（51.7%EDvs.48.3%诊所）。向急诊室就诊的人吸烟率较高(21.7%与16.0%,p=0.02),更有可能有2+合并症(47.2%与32.7%,p=0.011),并且更有可能拥有公共保险(43.5%与32.0%,p=0.043)。ED患者术前KPS较低(p<0.001),而Bilsky评分较高（p=0.049）。ED患者的寡转移疾病发生率较高（p=0.049），较高的总减压水平(p=0.041)，与临床患者相比，肋段切除术的发生率更高（p=0.031）。ED患者的住院时间明显更长（7.7±6.1vs.6.1±5.8天,p=0.020),他们不太可能出院回家(52.2%vs.69.3%,p=0.025)。ED表现与总生存期缩短显著相关(HR=1.5395%CI=1.13-2.08,p=0.006)。
结论：在脊柱转移性疾病患者中，大约一半通过ED与诊所。ED患者吸烟率较高，公共保险,和更高的Bilsky分数.ED患者还接受了更广泛的手术，有更长的LOS，不太可能出院回家，最重要的是,总生存期较短。这些结果表明，接受转移性脊柱疾病手术的患者的初次就诊显着影响预后。应尽快识别脊柱转移性疾病的体征/症状，以防止ED出现。
