To evaluate complications
in patients undergoing surgical management of extradural spinal tumors in New York State
Summary of Background Data.
Metastatic spine surgery has a high rate of complications
but most studies are limited to single institutions.
The Statewide Planning and Research Cooperative System was used to identify patients with extradural spinal tumors undergoing surgery in New York State
from 2006 to 2015. Bivariate and multivariate logistic regression analyses were used to estimate outcomes.
Four thousand seven hundred sixty-seven patients were identified, the majority of patients were male and white a median age of 61. The complication rate was 17.6% and the mortality
rate within 30 days of discharge was 12.2%. Multivariate analysis showed the odds of complications
were higher in males compared with females (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.05–1.52, P
= 0.01), and patients on Medicaid compared with patients on private insurance (OR: 1.42; 95% CI: 1.03–1.96, P
= 0.03). Analysis of hospital characteristics showed lower volume hospitals (OR 1.48; 95% CI: 1.03–2.13, P
value = 0.03), and teaching hospitals (OR: 1.47; 95% CI: 1.03–2.09, P
= 0.04), have higher odds of complications
compared with high-volume hospitals and nonteaching hospitals. Multivariate analysis showed higher odds of mortality
within 30 days of discharge in patients of older age (OR: 1.02; 95% CI: 1.01–1.03, P
value = 0.001), low-volume hospitals compared with high-volume hospitals (OR: 1.36; 95% CI: 1.09–1.79, P
value = 0.02), hospitals with low bed size compared with high bed size (OR: 1.43; 95% CI: 1.12–1.83, P
value = 0.01), and urban hospitals compared with rural hospitals (OR: 3.04; 95% CI: 2.03–4.56, P
value = 0.001).
Low-volume hospitals are associated with complications
in patients with metastatic spine disease
Level of Evidence: 3