Risk Factors for Early Postoperative Morbidity and Mortality following Extremity Metastatic Pathologic or Impending Fracture Fixation.

IF 1.6 Q4 ONCOLOGY
International Journal of Surgical Oncology Pub Date : 2024-09-12 eCollection Date: 2024-01-01 DOI:10.1155/2024/3565134
Patrick Qi Wang, Brynn P Charron, Kalter Hali, Matthew Raleigh, Christopher Del Balso, Mark D Macleod, David W Sanders, Abdel-Rahman Lawendy
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引用次数: 0

Abstract

Background: As cancer survivorship continues to improve, the perioperative morbidity and mortality following surgical treatment of metastatic bone disease become an increasingly important consideration. The objective of this study is to identify risk factors for early postoperative complications and mortality following extremity prophylactic fixation and pathologic fracture stabilization.

Methods: A single-centre retrospective review of 185 patients (226 total surgeries) who underwent prophylactic fixation or pathologic fracture stabilization for extremity metastatic bone disease between 2005 and 2020 was performed. Skull, spine, pelvic, and revision surgeries along with diagnosis of primary bone neoplasm were excluded. Univariate, multivariate, and subgroup analyses were performed to identify predictors and independent risk factors for 30-day postoperative morbidity and mortality.

Results: Primary cancers included lung (n = 41), breast (n = 36), multiple myeloma (n = 35), prostate (n = 16), lymphoma (n = 11), renal cell carcinoma (n = 10), and other (n = 36). The 30-day postoperative complication and mortality rates were 32.30% (n = 73) and 17.26% (n = 39), respectively. The most common complications were pulmonary-related, cardiac events, surgical site infection, sepsis, and thromboembolism. Pathologic fracture, presence of extra-skeletal metastases, longer surgical duration, and blood transfusion requirements were associated with 30-day postoperative complications overall. A past medical history for cardiac disease was also associated with systemic but not local surgical complications. Pathologic fracture, presence of extra-skeletal metastases, lung cancer, blood transfusion requirements, and increasing pack-year smoking history were predictors for 30-day mortality. In the multivariate analysis, pathologic fracture (p=0.016) and presence of extra-skeletal metastases (p=0.029) were independent predictors of complications. For mortality, pathologic fracture (p=0.014), presence of extra-skeletal metastases (p=0.0085), and increased blood transfusion requirements (p=0.048) were independent risk factors.

Conclusions: The findings of this study provide additional guidance for perioperative risk assessment and patient counselling. Additionally, improving clinical assessment tools to identify and quantify patients at risk of pathologic fractures becomes increasingly important given the significant morbidity and mortality associated with pathologic fracture treatment.

四肢转移性病理性骨折或即将发生的骨折固定术后早期发病率和死亡率的风险因素。
背景:随着癌症生存率的不断提高,转移性骨病手术治疗后的围手术期发病率和死亡率成为越来越重要的考虑因素。本研究旨在确定四肢预防性固定和病理性骨折稳定术后早期并发症和死亡率的风险因素:对 2005 年至 2020 年期间因四肢转移性骨病接受预防性固定或病理性骨折稳定术的 185 例患者(共 226 例手术)进行了单中心回顾性研究。颅骨、脊柱、骨盆和翻修手术以及原发性骨肿瘤诊断均被排除在外。进行了单变量、多变量和亚组分析,以确定术后30天发病率和死亡率的预测因素和独立风险因素:原发性癌症包括肺癌(41 例)、乳腺癌(36 例)、多发性骨髓瘤(35 例)、前列腺癌(16 例)、淋巴瘤(11 例)、肾细胞癌(10 例)和其他癌症(36 例)。术后 30 天的并发症和死亡率分别为 32.30%(73 例)和 17.26%(39 例)。最常见的并发症是肺部相关并发症、心脏事件、手术部位感染、败血症和血栓栓塞。病理性骨折、存在骨骼外转移瘤、手术时间较长以及需要输血与术后30天的总体并发症有关。既往心脏病史也与全身性手术并发症有关,但与局部手术并发症无关。病理性骨折、存在骨骼外转移瘤、肺癌、需要输血以及吸烟年数增加是30天死亡率的预测因素。在多变量分析中,病理性骨折(p=0.016)和骨骼外转移(p=0.029)是并发症的独立预测因素。就死亡率而言,病理性骨折(p=0.014)、存在骨骼外转移瘤(p=0.0085)和输血需求增加(p=0.048)是独立的风险因素:本研究结果为围术期风险评估和患者咨询提供了更多指导。此外,鉴于病理性骨折治疗带来的巨大发病率和死亡率,改进临床评估工具以识别和量化有病理性骨折风险的患者变得越来越重要。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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