Surgical results and clinical risks of postoperative complications in patients with painful malignant spinal cord compression after decompressive surgery
Authors Wang S, Wang Y, Yu Z, Gao K, Shao J, Li A, Gao Y
Received 13 January 2018
Accepted for publication 7 June 2018
Published 29 August 2018 Volume 2018:11 Pages 1679—1687
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Katherine Hanlon
Shengjie Wang,1 Yunhao Wang,2 Zhenghong Yu,1 Kun Gao,1 Jia Shao,1 Ang Li,1 Yanzheng Gao1
1Department of Orthopedics, Henan Provincial People’s Hospital, Zhengzhou, 450003, China; 2Department of Orthopedics, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
Introduction: This study aims to analyze clinical outcome in patients with painful malignant spinal cord compression due to advanced cancers after the decompressive surgery and identify risk factors for postoperative complications in these patients. Furthermore, we created a scoring model to predict the risk of postoperative complications based on identified significant risk factors.
Methods: We retrospectively analyzed survival outcomes, pain outcomes, and postoperative complications of patients with painful malignant spinal cord compression who were surgically treated in our department. Identification of risk factors for postoperative complications was also performed, and significant factors according to the multiple logistic regression models were included in the scoring model.
Results: As a result, 105 patients were enrolled. The overall median survival time was 9.1 months (95% CI, 7.1–11.4 months). The mean worst pain score was 8.0 in a 24-hour period before surgery, while it decreased to 6.0, 5.0, 3.5, 3.3, and 3.6 (all P<0.01, when compared with baseline date) at 1 week, 1 month, 3, 6, and 12 months after surgery, respectively. Similar decreases were also observed in the average pain and the pain interference. Thirty-one complications occurred within 4 weeks after operation in 26 patients (24.8%, 26/105). Based on multiple logistic regression models, age (P=0.03), Karnofsky performance status (P<0.01), and Charlson Comorbidity Index (P=0.04) were significantly associated with postoperative complications and were included in the scoring model. Three risk groups were created based on the complication rates of each scoring points. The corresponding postoperative complication rates of the three groups were 7.7% in group A (0–3 points), 26.7% in group B (4–6 points), and 60.9% in group C (7–10 points), respectively (OR, 4.32, 95% CI: 2.24–8.31, P<0.01).
Conclusion: Decompressive surgery for painful malignant spinal cord compression was found to be useful for pain control with a tolerable rate of complications. We created a scoring model to predict the risk of postoperative complications in patients with painful malignant spinal cord compression after surgery. This scoring model may guide doctors to choose the appropriate care strategies to realize better pain management.
Keywords: pain outcome, postoperative complication, malignant spinal cord compression, decompressive surgery, survival
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