Medical Student University at Buffalo Jacobs School of Medicine and Biomedical Sciences
Introduction: Surgical patient selection in Spinal Metastatic Disease(SMD) is complex, and patients who develop surgical complications or are not able to quickly begin systemic therapy may not survive. Numerous studies have evaluated clinical parameters that can be used to help predict outcomes following surgery for SMD. Patient discharge to facility has the potential to delay postoperative radiotherapy and systemic cancer therapy and anecdotally impacts overall survival, but to our knowledge the effect of discharge to facility on overall survival following surgery for SMD has not been previously evaluated.
Methods: Consecutive patients undergoing spinal surgery at an NCI-designated cancer institute were prospectively enrolled from September 2010 to November 2021 in an IRB approved study. Patient demographics including discharge disposition and survival following surgery at 3 months, 6 months,and 1 year were collected. Facility discharge(FD) included discharge to medical rehabilitation units and assisted living. Group differences were compared using the Fisher’s exact test, with p< 0.05 considered a significant difference.
Results: A total of 171 patients were included. Mean age was 62.7±10.46years and 40.9%(70) were female. Primary malignancy sites were lung(49),kidney(28),breast(25) and prostate(23). The average survival time for all patients was 32.4 months. Patients with home discharge(HD) disposition (155 patients, mean age 62.3±10.26 years) had a better overall survival outcome with 33.3 months as compared to FD patients at 21.8 months (p=0.2512). The 3-month survival for HD and FD patients was 82% and 68% respectively (p=0.1982),6-month survival rates for patients were 68% with HD and 50% with FD(p=0.1662),1-year survival, patients had a 50% survival rate with HD and 38% with FD(p=0.433). Average survival by primary site(months) was lung(22.8), prostate(27.9), kidney(42), breast(50).
Conclusion : Discharge to facility predicts worse overall survival in patients following surgery for SMD. This trend did not reach statistical significance, suggesting it may not be an independent predictor but rather a useful component to a scoring system when selecting surgical candidates in patients with SMD. Overall survival is improved compared to historical controls, suggesting improved outcomes secondary to recent advancements in systemic therapy. Given the overall prognosis in this patient population, clinical outcome prediction remains an important area of study.
