Background/Objectives:Metastatic spine disease (MSD) affects a significant proportion of patients with advanced malignancies and often necessitates surgical intervention to preserve neurological function, alleviate pain, and maintain spinal stability. While oncologic spine surgery is ideally performed in a planned, semi-elective setting, a substantial number of patients require unplanned (urgent or emergent) surgery due to acute deterioration. The impact of surgical planning status on postoperative outcomes following metastatic spine tumor surgery remains underexplored. This study aimed to compare the patient characteristics and short-term outcomes of those undergoing planned versus unplanned surgery for spinal metastases.Methods:We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2018 to 2023. Patients with disseminated cancer undergoing tumor surgery were identified. Case types were grouped into planned (elective) and unplanned (urgent or emergent). The primary endpoint was failure to rescue (FTR); secondary endpoints included 30-day major complications, 30-day mortality, and length of hospital stay. Univariable and multivariable regression analyses were performed.Results:A total of 2147 patients met our inclusion criteria, out of whom 60% (n= 1284) underwent planned and 40% (n= 863) underwent unplanned surgery. Patients in the unplanned surgery group had a significantly higher prevalence of severe hypoalbuminemia, severe anemia, and ASA class IV status (p≤ 0.001 for all). For our primary endpoint, a multivariable analysis showed a significant association between unplanned surgery and FTR (OR 2.11 [95% CI 1.24 to 3.56];p= 0.005). Significant associations were also found with 30-day mortality (OR 1.84 [95% CI 1.25 to 2.72];p= 0.002) and length of hospital stay (β 2.7 [95% CI 1.97 to 3.43];p< 0.001). However, unplanned surgery could not independently predict 30-day major complications (OR 1.21 [95% CI 0.97 to 1.51];p= 0.08).Conclusions:Our study found that unplanned surgery for spinal metastases was associated with significantly higher rates of FTR, 30-day mortality, and extended hospital stay, independent of other covariates. These findings highlight the importance of the timely identification of patients requiring surgery and the potential benefits of semi-elective care.
**背景/目的：** 转移性脊柱疾病（MSD）影响相当一部分晚期恶性肿瘤患者，通常需要手术干预以保留神经功能、缓解疼痛并维持脊柱稳定性。虽然肿瘤脊柱手术理想情况下应在有计划、半择期的状态下进行，但仍有大量患者因病情急性恶化而需要接受非计划（紧急或急诊）手术。手术计划状态对转移性脊柱肿瘤术后结局的影响尚未得到充分研究。本研究旨在比较因脊柱转移瘤接受计划手术与非计划手术患者的特征及短期结局。 **方法：** 我们利用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库（2018-2023年）进行了一项回顾性队列研究。筛选出接受肿瘤手术的播散性癌症患者。病例类型分为计划（择期）和非计划（紧急或急诊）。主要终点是救治失败（FTR）；次要终点包括30天主要并发症、30天死亡率和住院时间。进行了单变量和多变量回归分析。 **结果：** 共有2147名患者符合我们的纳入标准，其中60%（n=1284）接受了计划手术，40%（n=863）接受了非计划手术。非计划手术组患者严重低白蛋白血症、严重贫血和ASA IV级状态的发生率显著更高（所有p≤0.001）。对于主要终点，多变量分析显示非计划手术与FTR之间存在显著关联（OR 2.11 [95% CI 1.24-3.56]；p=0.005）。与30天死亡率（OR 1.84 [95% CI 1.25-2.72]；p=0.002）和住院时间（β 2.7 [95% CI 1.97-3.43]；p<0.001）也存在显著关联。然而，非计划手术不能独立预测30天主要并发症（OR 1.21 [95% CI 0.97-1.51]；p=0.08）。 **结论：** 我们的研究发现，脊柱转移瘤的非计划手术与显著更高的FTR率、30天死亡率和更长的住院时间相关，且独立于其他协变量。这些发现强调了及时识别需要手术的患者的重要性以及半择期治疗的潜在益处。
Short-Term Outcomes in Planned Versus Unplanned Surgery for Spinal Metastases
肿瘤(癌症)患者之家