Current trends in incidence, characteristics, and surgical management of metastatic breast cancer to the spine: A National Inpatient Sample analysis from 2005 to 2014. (September 2021)

• Record Type: Journal Article
• Authors: Peterson, Keyan A.; Zehri, Aqib H.; Lee, Katriel E.; Kittel, Carol A.; Evans, Joni K.; Wilson, Jonathan L.; Hsu, Wesley
• Is Part Of: Journal of clinical neuroscience. Volume 91(2021)
• Page Start: 99
• Page End: 104
• Publication Date: 2021-09
• Subjects: AHRQ Agency for Healthcare Research and Quality -- ANOVA Analysis of Variance -- CI Confidence Interval -- DVT Deep Venous Thrombosis -- ICD-9 CM International Classification of Diseases, 9th Edition, Clinical Modification -- MCBS Metastatic Breast Cancer to the Spine -- NIS National Inpatient Sample -- OR Odds Ratio -- VA Vertebral Augmentation; Spinal cord tumor -- Surgery -- Complications -- Hospitalization cost -- Nationwide Inpatient Sample -- Breast cancer; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.06.043
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: The authors present a decade-long analysis of the short-term outcomes in surgically managed metastatic breast cancer to the spine stratified by procedure performed. Notable surgical trends include an increase in the use of spinal stabilization procedures with a concomitant decrease in the use of vertebral augmentation procedures. A weighted logistic regression model is employed for prediction of short-term outcomes based on patient demographics, comorbidities and procedure type. Higher risk of complications was associated with more invasive procedures; this increased risk abated with increased pre-operative comorbidities. Abstract: Management of metastatic breast cancer to the spine (MBCS) incorporates a multimodal approach. Improvement in screening and nonsurgical therapies may alter the trends in surgical management of MBCS. The objective of this study is to assess trends in surgical management of MBCS and short-term outcomes based on the National Inpatient Sample (NIS) database. The NIS database was queried for patients with MBCS who underwent surgery from 2005 to 2014. The weighted frequencies of spinal decompression alone, spinal stabilization +/- decompression, and vertebral augmentation were calculated. Multivariate analysis was performed to analyze the effect of patient characteristics on outcomes stratified by procedure. The most common procedure performed was vertebral augmentation (11, 114, 53.4%), followed by stabilization +/− decompression (6, 906, 33.2%) and then decompression alone (3, 312, 13.4%). The total population-adjusted rate of surgical management for MBCS remained stable, while the rate of spinal stabilization increased (P < 0.001) and vertebral augmentation decreased (p < 0.003). The risk of complication increased with spinal stabilization and decompression compared to vertebral augmentation procedures in those with fewer comorbidities. This relative increase in risk abated in patients with higher numbers of pre-operative comorbidities. Any single complication was associated with increases in length of stay, cost, and mortality. The rate of in-hospital interventions remained stable over the study period. Stratified by procedure, the rate of stabilizations increased with a concomitant decrease in vertebral augmentations, which suggests that patients who require hospitalization for MBCS are becoming more likely to represent advanced cases that are not amenable to palliative vertebral augmentation procedures.