A comprehensive evaluation of intramedullary devices in the management of femoral metastasis: 30-day outcomes.

Abstract

Introduction: Bone metastases, affecting 40% to 60% of patients with metastatic disease, are a significant concern, with the femur being one of the most common sites. These metastases significantly impact quality of life and present complex treatment challenges. Intramedullary nailing (IMN) is frequently used for femoral metastases owing to its minimally invasive nature and favorable outcomes.

Methods: A retrospective cohort analysis was performed using data from the American College of Surgeons National Surgical Quality Improvement Program database (2016-2021). Patients aged 18 and older who underwent IMN for metastatic femoral disease were included. The primary endpoints were 30-day reoperation and readmission rates. Secondary endpoints assessed 30-day postoperative complications.

Results: The cohort primarily comprised female patients (62.7%, n = 482) with notable comorbidities such as hypertension (48.9%) and high smoking rates (71.3%). Low rates of specific reoperations (0.4%, n = 3) and unplanned reoperations (1.7%, n = 13) were observed within 30 days. The incidence of deep vein thrombosis was 1.2%, and the incidence of pulmonary embolism was 0.7%. Surgical site infections were rare (Figure 1).

Conclusion: IMN is a safe and effective surgical option for treating metastatic femoral lesions, providing a favorable safety profile. Further research is recommended to explore thromboembolic risks and optimize preventive strategies.