Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: N. Kumar

Author(s):

N. Kumar(1), A.S. Zaw(1), S. Wong(1), R.S. Patel(1), D. Hey(1), G. Liu(1)

(1) National University Health System, Orthopaedics, Singapore, Singapore

Abstract

Summary of Background Data: Patients with spinal metastases are elderly, high-risk patients with a shorter predicted survival. Deeper understanding of the factors influencing eLOS in these patients will assist both physicians and patients alike to better weigh the costs and benefits of spinal tumour surgery and aid in making an informed decision regarding admission and discharge as well as preoperative planning of surgical procedure. Extended LOS is well studied for elective surgeries; however, there is paucity of literature regarding LOS in patients undergoing MSTS.

Methods: We included all patients who underwent MSTS at our institution between 2005-2015. Data were retrieved by manually searching the case notes and hospital electronic records which included preoperative, intraoperative and postoperative variables as well as socioeconomic factors. The outcome measure was eLOS that we defined as positive when the LOS exceeded the 75th percentile for this cohort. Univariate and multivariate logistic regression analyses were performed to determine the predictive factors of eLOS.

Results: A total of 267 patients were included in the final analysis. The overall median LOS was 10 days (1-30 days) and 27% of patients had extended LOS (LOS≥16 days). Multivariate analysis revealed that significant variables independently associated with extended LOS were Charlson comorbidities index≥8, preoperative haemoglobin level≥12g/dl, 3 or more spinal segmental levels decompressed, presence of postoperative complications, absence of family support and discharge destination being community hospital.

Conclusions: The current study provides evidence that there are medical/surgical as well as socioeconomic factors influencing eLOS in patients undergoing MSTS. It will assist the health care providers for better resource allocation as well as enable metastatic spine patients to spend a larger proportion of their limited life span in their home or preferred environment.