title: Adverse events in emergency oncological spine surgery: a prospective analysis.
abstract: OBJECTIVE
  Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome. Emergency oncological spine surgeries are generally palliative to reduce pain and improve patients' neurology and health-related quality of life. In individuals with limited life expectancy, AEs can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process. The purpose of this study was to determine the true incidence of AEs associated with emergency oncological spine surgery.
  
  
  METHODS
  The authors carried out a prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected on standardized AE forms (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff.
  
  
  RESULTS
  A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventy-six patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases.
  
  
  CONCLUSIONS
  When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population.
authors.affiliation: Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada; and.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dea
authors.forename: Anne
authors.initials: A
authors.lastname: Versteeg
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kelly
authors.forename: Dennis
authors.initials: D
authors.lastname: Hartig
authors.forename: Michael
authors.initials: M
authors.lastname: Boyd
authors.forename: Scott
authors.initials: S
authors.lastname: Paquette
authors.forename: Brian K
authors.initials: BK
authors.lastname: Kwon
authors.forename: Marcel
authors.initials: M
authors.lastname: Dvorak
authors.forename: John
authors.initials: J
authors.lastname: Street
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
keywords: AE = adverse event; ASIA = American Spinal Injury Association; CCI = Charlson Comorbidity Index; SAVES V2 = Spine AdVerse Events Severity System, version 2; adverse events; oncology; spinal metastasis; spine surgery