Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients
IntroductionDelayed surgical management of spinal metastases (SMs) can have detrimental effects on patient survival and quality of life, leading to pain and potential neurological impairment. This study aimed to assess the impact of delayed referral for SMs on clinical outcomes by analyzing patients...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1301305/full |
| _version_ | 1797339154150850560 |
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| author | Bertrand Debono Alexis Perez Guillaume Lonjon Olivier Hamel Jean-Baptiste Dandine Martin Dupuy Guillaume Dutertre Cécile Braticevic Igor Latorzeff Aymeric Amelot |
| author_facet | Bertrand Debono Alexis Perez Guillaume Lonjon Olivier Hamel Jean-Baptiste Dandine Martin Dupuy Guillaume Dutertre Cécile Braticevic Igor Latorzeff Aymeric Amelot |
| author_sort | Bertrand Debono |
| collection | DOAJ |
| description | IntroductionDelayed surgical management of spinal metastases (SMs) can have detrimental effects on patient survival and quality of life, leading to pain and potential neurological impairment. This study aimed to assess the impact of delayed referral for SMs on clinical outcomes by analyzing patients managed in emergency situations.MethodsWe retrospectively reviewed the data of all patients admitted on either emergency or elective basis who underwent surgery for the treatment of neoplastic spine lesions at our two institutions (tertiary referral neurosurgical units) between January 2008 and December 2019.ResultsWe analyzed 210 elective (EGp) and 323 emergency patients (UGp); emergencies increased significantly over the 12-year period, with a Friday peak (39.3%) and frequent neurological impairment (61.6% vs. 20%). Among the UGp patients, 186 (7.5%) had a previously monitored primitive cancer, including 102 (31.6%) with known SMs. On admission, 71 of the 102 (69.9%) patients presented with neurological deficits. UGp patients were more likely to undergo a single decompression without fixation. Outcomes at the 3-month follow-up were significantly worse for UGp patients ([very] poor, 29.2 vs. 13.8%), and the median overall survival for UGp patients was statistically lower. Risk factors for patients with SM undergoing emergency management included short delay between onset of symptoms and first contact with a spine surgeon, and an initial motor deficit.ConclusionMany patients with previously identified metastases, including those with neurological deficits, are urgently referred. Optimization is needed in the oncology pathway, and all stakeholders must be made aware of the factors contributing to the improvement in the clinical and radiological identification of potential complications affecting patient survival and quality of life. |
| first_indexed | 2024-03-08T09:41:50Z |
| format | Article |
| id | doaj.art-7ab78ac2e5f443b98a636f35cae77400 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-08T09:41:50Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-7ab78ac2e5f443b98a636f35cae774002024-01-30T04:26:03ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-01-011410.3389/fonc.2024.13013051301305Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patientsBertrand Debono0Alexis Perez1Guillaume Lonjon2Olivier Hamel3Jean-Baptiste Dandine4Martin Dupuy5Guillaume Dutertre6Cécile Braticevic7Igor Latorzeff8Aymeric Amelot9Department of Neurosurgery, Paris-Versailles Spine Center, Hôpital privé de Versailles, Versailles, FranceDepartment of Neurosurgery, Clinique de l’Union, Toulouse, FranceDepartment of Orthopedic Surgery, Orthosud, Clinique St-Jean-Sud de France, Santé Cite Group, Montpellier Metropole, FranceDepartment of Neurosurgery, Clinique des Cédres, Toulouse, FranceDepartment of Neurosurgery, Clinique de l’Union, Toulouse, FranceDepartment of Neurosurgery, Clinique de l’Union, Toulouse, FranceInstitut Curie, Paris Sciences et Lettres (PSL) Research University, Surgical Oncology Department, Paris, FranceDepartment of Medical Oncology, Institut Paoli-Calmettes, Marseille, FranceDepartment of Radiotherapy, Groupe ONCORAD Garonne, Clinique Pasteur, Toulouse, FranceDepartment of Neurosurgery, Hopital Bretonneau, Tours, FranceIntroductionDelayed surgical management of spinal metastases (SMs) can have detrimental effects on patient survival and quality of life, leading to pain and potential neurological impairment. This study aimed to assess the impact of delayed referral for SMs on clinical outcomes by analyzing patients managed in emergency situations.MethodsWe retrospectively reviewed the data of all patients admitted on either emergency or elective basis who underwent surgery for the treatment of neoplastic spine lesions at our two institutions (tertiary referral neurosurgical units) between January 2008 and December 2019.ResultsWe analyzed 210 elective (EGp) and 323 emergency patients (UGp); emergencies increased significantly over the 12-year period, with a Friday peak (39.3%) and frequent neurological impairment (61.6% vs. 20%). Among the UGp patients, 186 (7.5%) had a previously monitored primitive cancer, including 102 (31.6%) with known SMs. On admission, 71 of the 102 (69.9%) patients presented with neurological deficits. UGp patients were more likely to undergo a single decompression without fixation. Outcomes at the 3-month follow-up were significantly worse for UGp patients ([very] poor, 29.2 vs. 13.8%), and the median overall survival for UGp patients was statistically lower. Risk factors for patients with SM undergoing emergency management included short delay between onset of symptoms and first contact with a spine surgeon, and an initial motor deficit.ConclusionMany patients with previously identified metastases, including those with neurological deficits, are urgently referred. Optimization is needed in the oncology pathway, and all stakeholders must be made aware of the factors contributing to the improvement in the clinical and radiological identification of potential complications affecting patient survival and quality of life.https://www.frontiersin.org/articles/10.3389/fonc.2024.1301305/fullspine metastasistumor boardreferraldelayemergencyspine surgery |
| spellingShingle | Bertrand Debono Alexis Perez Guillaume Lonjon Olivier Hamel Jean-Baptiste Dandine Martin Dupuy Guillaume Dutertre Cécile Braticevic Igor Latorzeff Aymeric Amelot Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients Frontiers in Oncology spine metastasis tumor board referral delay emergency spine surgery |
| title | Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients |
| title_full | Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients |
| title_fullStr | Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients |
| title_full_unstemmed | Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients |
| title_short | Enhancing the referral process for surgical management of spinal metastases: insights from a 12-year, bi-institutional study of 533 patients |
| title_sort | enhancing the referral process for surgical management of spinal metastases insights from a 12 year bi institutional study of 533 patients |
| topic | spine metastasis tumor board referral delay emergency spine surgery |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1301305/full |
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