title: Predictors of 30- and 90-Day Survival Following Surgical Intervention for Spinal Metastases: A Prognostic Study Conducted at Four Academic Centers.
abstract: METHODS
  A retrospective review.
  
  
  OBJECTIVE
  We sought to use data from 4 tertiary medical centers to explore surgical, medical, and demographic factors that influence survival within the first 90 days following surgery for spinal metastases.
  
  
  BACKGROUND
  Over the last 2 decades, patients with spinal metastases have become more likely to receive surgical intervention. The impact of surgical intervention and its potential benefits must be weighed against the risk of complications and peri-operative mortality. Risk factors that elevate the risk of mortality in the acute postoperative period are not well understood.
  
  
  METHODS
  All records of patients who underwent surgery for metastatic spinal disease at 1 of 4 academic medical centers in New England from 2007 to 2013 were obtained. Patient demographics, tumor characteristics, medical comorbidities, nutritional and functional status, as well as surgical variables were abstracted. Mortality was assessed for patients at 30 and 90 days following the procedure. Factors predictive of survival were assessed using bivariate logistic regression. Those factors with P values < 0.20 in the bivariate assessment were included in a final multivariable model that adjusted for confounders.
  
  
  RESULTS
  Between 2007 and 2013, 318 patients received surgical intervention for metastatic disease involving the spine. Cancer type did not influence the odds of survival at 30 days, while nutritional status and ambulatory capacity increased survival. Lung cancer significantly decreased the odds of survival at 90 days following surgery (odds ratio 0.36; 95% confidence interval 0.18-0.72), while ambulatory function and nutritional status remained significantly associated with improved survival.
  
  
  CONCLUSIONS
  This effort is one of the first to identify predictors of acute postoperative survival in a large series of patients treated for spinal metastases. Improved nutritional status and ambulatory function may enhance postoperative survival among individuals who undergo surgical intervention for spinal metastases.
  
  
  METHODS
  3.
authors.affiliation: *Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts†Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Dana A
authors.initials: DA
authors.lastname: Leonard
authors.forename: Ehsan
authors.initials: E
authors.lastname: Saadat
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.forename: Marco L
authors.initials: ML
authors.lastname: Ferrone
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D013125:Spinal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*
chemical_list: D012709:Serum Albumin