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Thirty-day Postoperative Complications After Surgery For Metastatic Long Bone Disease Are Associated With Higher Mortality at 1 Year.

转移性长骨疾病手术后 30 天的术后并发症与 1 年时较高的死亡率相关。

  • 影响因子:2.55
  • DOI:10.1097/CORR.0000000000001036
  • 作者列表:"Bindels BJJ","Thio QCBS","Raskin KA","Ferrone ML","Lozano Calderón SA","Schwab JH
  • 发表时间:2020-02-01
Abstract

BACKGROUND:The benefits of surgical treatment of a metastasis of the extremities may be offset by drawbacks such as potential postoperative complications. For this group of patients, the primary goal of surgery is to improve quality of life in a palliative setting. A better comprehension of factors associated with complications and the impact of postoperative complications on mortality may prevent negative outcomes and help surgeons in surgical decision-making. QUESTIONS/PURPOSES:(1) What is the risk of 30-day postoperative complications after surgical treatment of osseous metastatic disease of the extremities? (2) What predisposing factors are associated with a higher risk of 30-day complications? (3) Are minor and major 30-day complications associated with higher mortality at 1 year? METHODS:Between 1999 and 2016, 1090 patients with osseous metastatic disease of the long bones treated surgically at our institution were retrospectively included in the study. Surgery included intramedullary nailing (58%), endoprosthetic reconstruction (22%), plate-screw fixation (14%), dynamic hip screw fixation (2%), and combined approaches (4%). Surgery was performed if patients were deemed healthy enough to proceed to surgery and wished to undergo surgery. All data were retrieved by manually reviewing patients' records. The overall frequency of complications, which were defined using the Clavien-Dindo classification system, was calculated. We did not include Grade I complications as postoperative complications and complications were divided into minor (Grade II) and major (Grades III-V) complications. A multivariate logistic regression analysis was used to identify factors associated with 30-day postoperative complications. A Cox regression analysis was used to assess the association between postoperative complications and overall survival. RESULTS:Overall, 31% of the patients (333 of 1090) had a postoperative complication within 30 days. The following factors were independently associated with 30-day postoperative complications: rapidly growing primary tumors classified according to the modified Katagiri classification (odds ratio 1.6; 95% confidence interval, 1.1-2.2; p = 0.011), multiple bone metastases (OR 1.6; 95% CI, 1.1-2.3; p = 0.008), pathologic fracture (OR 1.5; 95% CI, 1.1-2.0; p = 0.010), lower-extremity location (OR 2.2; 95% CI, 1.6-3.2; p < 0.001), hypoalbuminemia (OR 1.7; 95% CI, 1.2-2.4; p = 0.002), hyponatremia (OR 1.5; 95% CI, 1.0-2.2; p = 0.044), and elevated white blood cell count (OR 1.6; 95% CI, 1.1-2.4; p = 0.007). Minor and major postoperative complications within 30 days after surgery were both associated with greater 1-year mortality (hazard ratio 1.6; 95% CI, 1.3-1.8; p < 0.001 and HR 3.4; 95% CI, 2.8-4.2, respectively; p < 0.001). CONCLUSION:Patients with metastatic disease in the long bones are vulnerable to postoperative adverse events. When selecting patients for surgery, surgeons should carefully assess a patient's cancer status, and several preoperative laboratory values should be part of the standard work-up before surgery. Furthermore, 30-day postoperative complications decrease survival within 1 year after surgery. Therefore, patients at a high risk of having postoperative complications are less likely to profit from surgery and should be considered for nonoperative treatment or be monitored closely after surgery. LEVEL OF EVIDENCE:Level III, therapeutic study.

摘要

背景: 手术治疗四肢转移的益处可能被潜在的术后并发症等缺点所抵消。对于这组患者,手术的首要目标是改善姑息性环境下的生活质量。更好地理解与并发症相关的因素和术后并发症对死亡率的影响可能会预防负面结果,并帮助外科医生进行手术决策。 问题/目的 :( 1) 四肢骨性转移性疾病手术治疗后 30 天并发症的风险如何?(2) 哪些诱发因素与 30 天并发症的高风险相关?(3) 轻微和严重的 3 0 天并发症是否与 1 年时较高的死亡率相关? 方法: 在 1999 ~ 2016 之间,患者 1090 例,骨性转移性疾病长骨的行手术治疗,在我们的机构回顾性纳入研究.手术包括髓内钉固定 (58%) 、假体内重建 (2 2% )) 、钢板螺钉固定 (14%) 、动力髋螺钉固定 (2% )) 和联合入路 (4%)。如果患者被认为健康到可以进行手术并希望接受手术,则进行手术。通过手动查看患者记录检索所有数据。计算使用Clavien-Dindo分类系统定义的并发症的总体频率。我们不包括 ⅰ 级并发症,因为术后并发症和并发症分为轻微 (ⅱ 级) 和重大 (ⅲ-ⅴ 级) 并发症。采用多变量logistic回归分析确定与术后 30 天并发症相关的因素。采用Cox回归分析评估术后并发症与总生存率之间的关系。 结果: 总体而言,31% 的患者 (333 例中的 1090 例) 在术后 30 天内出现并发症。以下因素与术后 30 天并发症独立相关: 根据改良Katagiri分类的快速生长原发肿瘤 (比值比 1.6; 95% 置信区间,1.1-2.2; p = 0.011) 、多发骨转移 (OR 1.6; 95% CI,1.1-2.3; p = 0.008) 、病理性骨折 (OR 1.5;95% CI,1.1-2.0; p = 0.010) 、下肢位置 (OR 2.2; 95% CI,1.6-3.2; p < 0.001) 、低白蛋白血症 (OR 1.7; 95% CI,1.2-2.4; p = 0.002) 、低钠血症 (OR 1.5; 95% CI,1.0-2.2; p = 0.044) 和白细胞计数升高(OR 1.6; 95% CI,1.1-2.4; p = 0.007)。术后 30 天内的次要和主要术后并发症均与较高的 1 年死亡率相关 (风险比 1。6; 95% CI,1。3-1.8; p < 0.00 1 和HR 3.4; 95% CI,分别为 2.8-4.2; p < 0.00 1)。 结论: 长骨转移性疾病患者易发生术后不良事件。在选择手术患者时,外科医生应仔细评估患者的癌症状况,几个术前实验室值应作为手术前标准检查的一部分。此外,术后 30 天的并发症降低了术后 1 年内的生存率。因此,术后并发症风险高的患者不太可能从手术中获益,应考虑非手术治疗或术后密切监测。 证据级别: III级,治疗性研究。

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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