Background/Objectives: Failure to rescue (FTR), defined as the occurrence of a major complication plus death within 30 days, is a key measure of surgical safety. Hypoalbuminemia is a known risk factor for poor outcome in metastatic spinal tumor surgery, yet its association with FTR has not been explored. The purpose of this study is to evaluate serum albumin level as predictor of FTR after surgery for spinal metastases.Methods: A total of 1749 patients with disseminated cancer who underwent oncologic surgery for spinal metastases (identified by CPT codes) and met our inclusion criteria were identified in the ACS-NSQIP database (2018–2023). The primary endpoint was FTR, defined as a major complication plus death occurring within 30 days of surgery. Serum albumin was analyzed both as a continuous and categorical variable (hypoalbuminemia < 3.5 g/dL, normal albumin > 3.5 g/dL). Univariable and multivariable logistic regression was performed, adjusting for demographic and operative variables.Results: The mean preoperative serum albumin level was 3.63 g/dL (standard deviation = 0.642) and the FTR rate was 4% (71 of 1749). After adjusting for potential confounders such as modified Frailty Index 5, ASA class, functional status, emergent case, and reoperation, higher preoperative albumin levels (OR 0.39 [95% CI 0.26–0.61];p< 0.001) were independently associated with decreased odds of FTR.Conclusions: The findings of this study suggest an association between preoperative serum albumin level and FTR in oncologic surgery for spinal metastases. This highlights the importance of albumin assessment for perioperative prognosis, but the findings require further validation.
背景/目的：救治失败（FTR）定义为发生主要并发症并在30天内死亡，是衡量手术安全性的关键指标。低白蛋白血症是已知的转移性脊柱肿瘤手术预后不良的风险因素，但其与FTR的关联尚未被探讨。本研究旨在评估血清白蛋白水平作为脊柱转移瘤术后FTR预测指标的价值。 方法：从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）中，共筛选出1749例符合纳入标准的播散性癌症患者，这些患者均接受了脊柱转移瘤肿瘤外科手术（通过当前 procedural terminology 代码识别）。主要终点是FTR，定义为术后30天内发生主要并发症并死亡。血清白蛋白既作为连续变量也作为分类变量（低白蛋白血症<3.5 g/dL，正常白蛋白>3.5 g/dL）进行分析。在调整人口统计学和手术变量的基础上，进行了单变量和多变量逻辑回归分析。 结果：术前平均血清白蛋白水平为3.63 g/dL（标准差=0.642），FTR发生率为4%（1749例中的71例）。在调整了改良衰弱指数5、美国麻醉医师协会分级、功能状态、急诊手术和再次手术等潜在混杂因素后，较高的术前白蛋白水平（比值比 0.39 [95% 置信区间 0.26–0.61]；p < 0.001）与FTR发生几率降低独立相关。 结论：本研究结果表明，在脊柱转移瘤的肿瘤外科手术中，术前血清白蛋白水平与FTR存在关联。这凸显了白蛋白评估对于围手术期预后的重要性，但研究结果尚需进一步验证。
肿瘤(癌症)患者之家