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Perioperative Complications of Spinal Metastases Surgery

Luksanapruksa, Panya MD; Buchowski, Jacob M. MD, MS; Zebala, Lukas P. MD; Kepler, Christopher K. MD, MBA; Singhatanadgige, Weerasak MD, MS; Bumpass, David B. MD

doi: 10.1097/BSD.0000000000000484
Narrative Review

The incidence of symptomatic spinal metastasis has increased due to treatment improvements and longer patient survival. More patients with spinal tumors are choosing operative treatment with an associated increased rate of perioperative complications. Operative metastatic disease treatment complication rates have also increased with overall rates ranging from 5.3% to 76.20%. The common surgical-related complications are iatrogenic dural injury and wound complications. The most common postoperative medical complications are delirium, pneumonia, and deep vein thrombosis. Risk factors for perioperative complications after spinal metastatic surgery include older age, multilevel of spinal metastases, preoperative irradiation, low preoperative Karnofsky Performance Score (10–40) and multiple comorbidities. Charlson Comorbidity Index and New England Spinal Metastasis Score were significant predictor of 30-day complications. The reoperation rate is 10.7%, and the reoperation is most commonly performed in the same admission. In addition, the 30-day mortality rate in this patient population is ∼7% (0.9%–13%) and is influenced by the type of cancer, disease burden, and patient comorbidities. We reviewed the prevalence and risk factors of common perioperative complications that occur with surgical treatment of metastatic spine disease, in an effort to guide the spine surgeon in anticipating and potentially avoiding these complications.

*Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Department of Orthopedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO

Department of Orthopedics, Rothman Institute, Thomas Jefferson University, Philadelphia, PA

§Department of Orthopedic Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand

Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR

L.P.Z: consultant for K2M, Inc., Medtronic, Inc., and has speaking arrangements with DePuy Synthes, Inc., Medtronic, Inc., and Ulrich Medical. Washington University receives spine fellowship support from AO North America and OMeGA. J.M.B: receives royalties from Globus Medical, Inc., K2M, Inc., and Wolters Kluwer Health/Lippincott Williams & Wilkins. He is a consultant for DePuy Synthes, Inc., Globus Medical, Inc., K2M, Inc., Medtronic, Inc., and Stryker, Inc. and has speaking arrangements with DePuy Synthes, Inc., Globus Medical, Inc., and Stryker, Inc. Washington University receives spine fellowship support from AO North America and OMeGA. The other authors have no conflict of interest to declare.

Reprints: Jacob M. Buchowski, MD, MS, Department of Orthopedic Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110 (e-mail: buchowskij@wustl.edu).

Received December 3, 2015

Accepted November 2, 2016

© 2017 by Lippincott Williams & Wilkins, Inc.