Mortality and complications following stabilization of femoral metastatic lesions: a population-based study of regional variation and outcome.
BACKGROUND: It is considered that patients at risk for spontaneous fracture due to metastatic lesions should undergo surgical stabilization before fracture occurs; however, prophylactic stabilization is associated with surgical morbidity and mortality. We sought to compare pathological fracture fixation versus prophylactic stabilization of diaphyseal femoral lesions for patients with femoral metastases and assess the rate of prophylactic surgery completed in all regions of Ontario. METHODS: Using population data sets, we identified all patients who had undergone femoral stabilization, either for pathological femoral fractures or for prophylactic fixation of femoral metastases before pathological fractures, between 1992 and 1997 in Ontario. We compared the rates of survival, serious medical and surgical complications and length of stay in hospital between the 2 groups. RESULTS: A total of 624 patients underwent surgical stabilization for femoral metastases. The most common sites of primary metastases were the lungs (26%), breasts (16%), kidneys (6%) and prostate (6%); 46% of patients had other or multiple primary metastases. Overall, 37% of lesions were fixed prophylactically, with wide variation by region (17.6%-72.2%). Patients who underwent prophylactic stabilization had better overall survival at all postoperative time points. This held true after adjusting for age, sex, comorbidities and type of cancer (p < 0.001). CONCLUSION: These data demonstrate a survival advantage with prophylactic fixation of metastatic femoral lesions combined with a relatively low perioperative risk excluding concomitant bilateral procedures. Ontario regional rates of prophylactic fixation vary enormously, with most patients not receiving prophylactic treatment.
Ristevski
Bill
B
Divisions of Orthopedics at the University of Toronto, Sunnybrook Health Sciences Centre and.
Jenkinson
Richard J
RJ
Stephen
David J G
DJ
Finkelstein
Joel
J
Schemitsch
Emil H
EH
McKee
Michael D
MD
Kreder
Hans J
HJ
Clin Orthop Relat Res. 2003 Oct;(415 Suppl):S230-44
14600615
Acta Orthop Scand Suppl. 2001 Jun;72(302):2p., 1-29
11582636
Clin Orthop Relat Res. 1986 Sep;(210):18-30
3757360
J Clin Epidemiol. 1992 Jun;45(6):613-9
1607900
J Trauma. 2004 Aug;57(2):333-9
15345982
J Bone Joint Surg Am. 1997 Jun;79(6):917-32
9199392
J Surg Oncol. 1998 May;68(1):41-7
9610662
South Med J. 2001 Apr;94(4):394-6
11332904
Injury. 2001 May;32(4):299-306
11325366
Ann Biomed Eng. 2007 Apr;35(4):642-50
17286207
J Bone Joint Surg Am. 2006 Jan;88(1):55-70
16391250
Clin Orthop Relat Res. 1996 Nov;(332):80-9
8913148
Clin Orthop Relat Res. 2003 Oct;(415 Suppl):S245-53
14600616
Int Orthop. 2000;24(2):101-3
10894380
Acta Orthop. 2006 Jun;77(3):474-81
16819688
Clin Orthop Relat Res. 2007 Jun;459:139-45
17545762
Radiother Oncol. 2003 Oct;69(1):21-31
14597353
Can J Surg. 2003 Dec;46(6):427-31
14680349
J Surg Oncol. 1997 Mar;64(3):190-4
9121148
Acta Orthop Scand. 2000 Apr;71(2):147-52
10852320
Spine J. 2001 Sep-Oct;1(5):382
14588322
Eur J Surg. 2000 Mar;166(3):247-54
10755341
Clin Orthop Relat Res. 1989 Dec;(249):256-64
2684463