2024 Volume 15 Issue 6 Pages 893-900
Introduction: Evaluating the risk of postoperative complications is essential for making decisions in patients with spinal metastases. Recent studies have shown that frailty is a predictor of surgical outcomes in cancer surgery and spinal surgery. However, the association of frailty with postoperative complications in spinal metastasis surgery remains controversial. Therefore, the aim of this study was to elucidate the risk factors for postoperative complications in spinal metastasis surgery with a focus on frailty.
Methods: A total of 241 patients with spinal metastases who underwent palliative surgery from 2015 to 2021 at our institution were enrolled. The Clavien-Dindo classification was used to assess postoperative complications with scores ≥ Grade II defined as complications. Data regarding demographics (age, sex, body mass index, and primary cancer) and preoperative clinical factors (new Katagiri score, Frankel grade, performance status, radiotherapy, chemotherapy, spinal instability neoplastic score, modified Frailty Index-11 (mFI), diabetes mellitus, and serum albumin levels) were collected. Univariable and multivariable analyses were performed to identify independent risk factors for postoperative complications (p < 0.05).
Results: In 47 of 241 (19.5%) patients, 57 postoperative complications were observed. The most common complications were wound infection/dehiscence, urinary tract infection, and pneumonia. On univariable analysis, male sex (p = 0.098), preoperative radiotherapy (p = 0.028), mFI (p < 0.001), Frankel classification (p = 0.051) and preoperative molecular targeted drugs (p = 0.030) were considered potential risk factors. The cut-off value of mFI was calculated to be 0.23 (sensitivity, 46.8%; specificity, 79.9%). On multivariate analysis, mFI ≥ 0.23 (odds ratio (OR), 2.82; 95% confidence interval (CI), 1.39-5.70; p = 0.003) and preoperative radiotherapy (OR, 2.11; 95% CI, 1.00-4.44; p = 0.049) were identified as significant risk factors. In particular, urinary tract infection (p = 0.012) and pneumonia (p = 0.037) were associated with mFI ≥ 0.23. Furthermore, the severity of postoperative complications was positively correlated with mFI (p < 0.001).
Conclusions: An mFI ≥ 0.23 and history of preoperative radiotherapy were associated with postoperative complications of spinal metastasis surgery.
