{"title":"脊柱转移手术治疗的术后效果因机构功能而异吗？：日本全国行政数据库分析。","authors":"Kentaro Yamada, Mikayo Toba, Hiroyuki Sato, Satoru Egawa, Shingo Morishita, Yu Matsukura, Takashi Hirai, Akihiro Hirakawa, Atsushi Kudo, Kiyohide Fushimi, Toshitaka Yoshii","doi":"10.1097/BSD.0000000000001885","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Objective: </strong>To investigate the impact of institutional function (cancer center and surgical volume for spine surgery) on in-hospital outcomes after surgical treatment for spinal metastasis using a nationwide administrative database.</p><p><strong>Summary of background data: </strong>Multidisciplinary approaches to bone metastasis have become common in Japan, especially in cancer centers. However, whether treatment outcomes for spinal metastasis surgery differ by institutional function remains controversial.</p><p><strong>Methods: </strong>Data of patients who underwent surgical procedures for spinal metastasis between 2012 and 2020 were extracted from the Diagnosis Procedure Combination database. In-hospital outcomes included in-hospital mortality, 30-day mortality, length of stay until discharge home, postoperative complications, and unfavorable ambulatory status. Univariate and multivariate analyses were performed to investigate the association between cancer center/surgical volume and each outcome while adjusting for potential confounders.</p><p><strong>Results: </strong>A total of 10,320 patients were included in this study. Among them, 5261 patients were treated at cancer centers. The median annual surgical volume for spine surgery was 166 cases. The 30-day mortality was lower in cancer centers than in noncancer centers [odds ratio (OR): 0.841, 95% CI: 0.709-0.999, P=0.0483] and in high-volume hospitals for spine surgery than in low-volume hospitals (OR per 50 cases: 0.958, 95% CI: 0.928-0.990, P=0.0101). The length of stay until discharge home, postoperative complications, and postoperative unfavorable ambulatory status did not differ by cancer center or surgical volume.</p><p><strong>Conclusion: </strong>The short-term mortality was lower in cancer centers or high-volume hospitals, whereas postoperative complications and ambulatory outcomes did not differ by institutional function. A deeper understanding of the multidisciplinary approaches or processes of care adopted at these institutions might be important to deliver similar outcomes in other hospitals to patients with spinal metastasis.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":10457,"journal":{"name":"Clinical Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Do Postoperative Outcomes of Surgical Treatment for Spinal Metastasis Differ by Institutional Function?: Analysis of a Nationwide Administrative Database in Japan.\",\"authors\":\"Kentaro Yamada, Mikayo Toba, Hiroyuki Sato, Satoru Egawa, Shingo Morishita, Yu Matsukura, Takashi Hirai, Akihiro Hirakawa, Atsushi Kudo, Kiyohide Fushimi, Toshitaka Yoshii\",\"doi\":\"10.1097/BSD.0000000000001885\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Objective: </strong>To investigate the impact of institutional function (cancer center and surgical volume for spine surgery) on in-hospital outcomes after surgical treatment for spinal metastasis using a nationwide administrative database.</p><p><strong>Summary of background data: </strong>Multidisciplinary approaches to bone metastasis have become common in Japan, especially in cancer centers. However, whether treatment outcomes for spinal metastasis surgery differ by institutional function remains controversial.</p><p><strong>Methods: </strong>Data of patients who underwent surgical procedures for spinal metastasis between 2012 and 2020 were extracted from the Diagnosis Procedure Combination database. In-hospital outcomes included in-hospital mortality, 30-day mortality, length of stay until discharge home, postoperative complications, and unfavorable ambulatory status. Univariate and multivariate analyses were performed to investigate the association between cancer center/surgical volume and each outcome while adjusting for potential confounders.</p><p><strong>Results: </strong>A total of 10,320 patients were included in this study. Among them, 5261 patients were treated at cancer centers. The median annual surgical volume for spine surgery was 166 cases. The 30-day mortality was lower in cancer centers than in noncancer centers [odds ratio (OR): 0.841, 95% CI: 0.709-0.999, P=0.0483] and in high-volume hospitals for spine surgery than in low-volume hospitals (OR per 50 cases: 0.958, 95% CI: 0.928-0.990, P=0.0101). The length of stay until discharge home, postoperative complications, and postoperative unfavorable ambulatory status did not differ by cancer center or surgical volume.</p><p><strong>Conclusion: </strong>The short-term mortality was lower in cancer centers or high-volume hospitals, whereas postoperative complications and ambulatory outcomes did not differ by institutional function. A deeper understanding of the multidisciplinary approaches or processes of care adopted at these institutions might be important to deliver similar outcomes in other hospitals to patients with spinal metastasis.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":10457,\"journal\":{\"name\":\"Clinical Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-09-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Spine Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BSD.0000000000001885\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Spine Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BSD.0000000000001885","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Do Postoperative Outcomes of Surgical Treatment for Spinal Metastasis Differ by Institutional Function?: Analysis of a Nationwide Administrative Database in Japan.
Study design: Retrospective comparative study.
Objective: To investigate the impact of institutional function (cancer center and surgical volume for spine surgery) on in-hospital outcomes after surgical treatment for spinal metastasis using a nationwide administrative database.
Summary of background data: Multidisciplinary approaches to bone metastasis have become common in Japan, especially in cancer centers. However, whether treatment outcomes for spinal metastasis surgery differ by institutional function remains controversial.
Methods: Data of patients who underwent surgical procedures for spinal metastasis between 2012 and 2020 were extracted from the Diagnosis Procedure Combination database. In-hospital outcomes included in-hospital mortality, 30-day mortality, length of stay until discharge home, postoperative complications, and unfavorable ambulatory status. Univariate and multivariate analyses were performed to investigate the association between cancer center/surgical volume and each outcome while adjusting for potential confounders.
Results: A total of 10,320 patients were included in this study. Among them, 5261 patients were treated at cancer centers. The median annual surgical volume for spine surgery was 166 cases. The 30-day mortality was lower in cancer centers than in noncancer centers [odds ratio (OR): 0.841, 95% CI: 0.709-0.999, P=0.0483] and in high-volume hospitals for spine surgery than in low-volume hospitals (OR per 50 cases: 0.958, 95% CI: 0.928-0.990, P=0.0101). The length of stay until discharge home, postoperative complications, and postoperative unfavorable ambulatory status did not differ by cancer center or surgical volume.
Conclusion: The short-term mortality was lower in cancer centers or high-volume hospitals, whereas postoperative complications and ambulatory outcomes did not differ by institutional function. A deeper understanding of the multidisciplinary approaches or processes of care adopted at these institutions might be important to deliver similar outcomes in other hospitals to patients with spinal metastasis.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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