The value of palliative surgery for metastatic spinal disease: satisfaction of patients and their families.
BACKGROUND
Although there have been several studies in which the surgical outcomes were evaluated by pain reduction or neurological improvement, there have been few studies focused on the quality of life (QOL) of the patients after the surgery. We considered that the most important consideration in palliative surgery was to respect the wishes of patients and their families, which are likely to be influenced by the patients' QOL for their limited life span.


OBJECTIVE
To evaluate the value of palliative surgery for spinal metastasis and to identify the factors predicting satisfaction of patients and their families after the surgery.


METHODS
Questionnaire-based survey of palliative surgery for spinal metastasis.


METHODS
Seventy-one consecutive patients who had undergone palliative surgery and their families.


METHODS
Survival period after surgery, neurological status, ambulatory period, pain scale, and satisfaction of patients and their families.


METHODS
The QOL of the patients after surgery was evaluated by analyzing the satisfaction and related parameters of patients and their families. Questionnaires were sent to 71 consecutive patients who had undergone palliative surgery for spinal metastasis. To identify the factors predicting satisfaction of patients and their families, multivariate logistic regression analyses were performed.


RESULTS
Questionnaires were successfully delivered to 71 patients or their families. Full responses were collected from 37 patients, giving an overall response rate of 52.2%. Overall, 80% of patients were satisfied with the results of the surgical treatment. Age (below 65 years) and neurological improvement after surgery were significant predictors of patient's satisfaction. Pain reduction and the continued survival of the patient were significant predictors of family member's satisfaction.


CONCLUSIONS
These results strongly suggested that palliative surgery is a valuable treatment for metastatic spinal disease. Younger patients were more likely to want active treatment and to seek any functional improvement that contributed to an improved QOL in their limited life span. Pain control and the length of patient survival were important factors for people caring for patients.
Fujibayashi
Shunsuke
S
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. shfuji@kuhp.kyoto-u.ac.jp
Neo
Masashi
M
Miyaki
Koichi
K
Nakayama
Takeo
T
Nakamura
Takashi
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D010166:Palliative Care; D057240:Patient Preference; D017060:Patient Satisfaction; D011788:Quality of Life; D013125:Spinal Neoplasms / Q000523:psychology / Q000556:secondary / Q000601:surgery; D011795:Surveys and Questionnaires