Outcomes and efficiency of managing patients admitted for surgery for spinal metastases

Abstract

Background: This study evaluated the current pathways for dealing with patients admitted for surgery to address spinal metastases. Methods: In this retrospective analysis (2016–2021), the following variables were studied admission, demographics, length of stay, critical care admission, hospital costs, primary cancer, and average survival. Results: There were 306 patients admitted from 2016 to 2021; 66 were planned admissions, 203 were emergency admissions, and 37 were day case admission. Patients averaged 65.4 years old. About 75% (203) were emergently admitted, while 25% (66) had planned elective admissions. Their respective lengths of stay were 16.5 versus 5.74 days. Interestingly, nearly half of the emergency admissions (46.3%) did not have surgery during that admission. The most common level for metastatic disease was the thoracic spine in both groups (53% in the elective vs. 62% emergency groups). The most common primary lesions included lung, breast, and prostate in both groups. The average survival in the emergency admission group was 9.1 months and the planned admission group was 13.07 months. Notably, the costs of emergent care were much higher than planned admissions. Conclusion: The pathway for spinal metastases is unique in that though there is a pathway for late-stage disease, there is not one for early disease. As a result, the majority of patients admitted for surgery for spinal metastases come in as an emergency rather than as a planned admission. Yet, close to half do not end up having surgery during that emergency admission to the spinal center. The cost of emergency care is significantly higher versus planned elective care for spinal metastatic disease. A service transformation is suggested to combat these problems with a pathway for managing all spinal metastases, rather than just metastatic spinal cord compression.