Incidence and treatment patterns in hospitalizations for malignant spinal cord compression in the United States, 1998-2006.
OBJECTIVE
To characterize patterns in incidence, management, and costs of malignant spinal cord compression (MSCC) hospitalizations in the United States, using population-based data.


METHODS
Using the Nationwide Inpatient Sample, an all-payer healthcare database representative of all U.S. hospitalizations, MSCC-related hospitalizations were identified for the period 1998-2006. Cases were combined with age-adjusted Surveillance, Epidemiology and End Results cancer death data to estimate annual incidence. Linear regression characterized trends in patient, treatment, and hospital characteristics, costs, and outcomes. Logistic regression was used to examine inpatient treatment (radiotherapy [RT], surgery, or neither) by hospital characteristics and year, adjusting for confounding.


RESULTS
We identified 15,367 MSCC-related cases, representing 75,876 hospitalizations. Lung cancer (24.9%), prostate cancer (16.2%), and multiple myeloma (11.1%) were the most prevalent underlying cancer diagnoses. The annual incidence of MSCC hospitalization among patients dying of cancer was 3.4%; multiple myeloma (15.0%), Hodgkin and non-Hodgkin lymphomas (13.9%), and prostate cancer (5.5%) exhibited the highest cancer-specific incidence. Over the study period, inpatient RT for MSCC decreased (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.61-0.81), whereas surgery increased (OR 1.48, 95% CI 1.17-1.84). Hospitalization costs for MSCC increased (5.3% per year, p < 0.001). Odds of inpatient RT were greater at teaching hospitals (OR 1.41, 95% CI 1.19-1.67), whereas odds of surgery were greater at urban institutions (OR 1.82, 95% CI 1.29-2.58).


CONCLUSIONS
In the United States, patients dying of cancer have an estimated 3.4% annual incidence of MSCC requiring hospitalization. Inpatient management of MSCC varied over time and by hospital characteristics, with hospitalization costs increasing. Future studies are required to determine the impact of treatment patterns on MSCC outcomes and strategies for reducing MSCC-related costs.
Mak
Kimberley S
KS
Harvard Medical School, Boston, MA, USA.
Lee
Leslie K
LK
Mak
Raymond H
RH
Wang
Shuang
S
Pile-Spellman
John
J
Abrahm
Janet L
JL
Prigerson
Holly G
HG
Balboni
Tracy A
TA
D000328:Adult; D005260:Female; D006689:Hodgkin Disease / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006780:Hospitals, Rural; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008175:Lung Neoplasms / Q000453:epidemiology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000453:epidemiology; D015995:Prevalence; D011471:Prostatic Neoplasms / Q000453:epidemiology; D018426:SEER Program; D013117:Spinal Cord Compression / Q000453:epidemiology* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D013125:Spinal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology