title: Key Preoperative Clinical Factors Predicting Outcome in Surgically Treated Patients with Metastatic Epidural Spinal Cord Compression: Results from a Survey of 438 AOSpine International Members.
abstract: OBJECTIVE
  Accurate prediction of surgical outcomes in patients suffering from metastatic epidural spinal cord compression (MESCC) is challenging. This survey aims to obtain expert opinion on which preoperative clinical factors are the most relevant predictors of survival, neurologic, functional, and health-related quality of life (HRQoL).
  
  
  METHODS
  Members of AOSpine International were invited to participate in a 15-question electronic survey. Results from the entire sample and differences across geographic regions and between neurosurgeons and orthopedic surgeons were analyzed. Factors endorsed by over 50% of the respondents were considered key predictors.
  
  
  RESULTS
  Among AOSpine members, 438 responded. The absence of visceral metastasis (n = 335; 76.48%) and the site of primary tumor (n = 228; 52.05%) were identified as important predictors for survival. Frankel/American Spinal Injury Association grade D or E and the ability to walk were common to neurologic (n = 344; 78.54% and n = 238; 54.34%, respectively); functional (n = 269; 61.42% and n = 243; 55.48%, respectively); and HRQoL outcomes (n = 241; 55.02% and n = 242; 55.25%, respectively). While the absence of bowel/bladder/sexual dysfunction was common to neurologic (n = 260; 59.36%) and HRQoL (n = 229; 52.28%) outcomes, a high Karnofsky/Eastern Cooperative Oncology Group performance status was common to functional (n = 237; 54.11%) and HRQoL (n = 221; 50.46%) outcomes. There was overall consistency across specialities and geographic regions.
  
  
  CONCLUSIONS
  Neurosurgeons and orthopedic surgeons and respondents from different geographic regions generally identified similar preoperative clinical factors as key predictors of survival, neurologic, functional, and HRQoL outcomes in surgical MESCC patients. The results of this survey will inform the development of clinical prediction rules for survival and HRQoL in MESCC patients selected for surgery to maximize their clinical relevance.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anick
authors.initials: A
authors.lastname: Nater
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Lindsay L
authors.initials: LL
authors.lastname: Tetreault
authors.affiliation: Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Institute of Health Policy, Management and Evaluation, Departments of Physical Therapy and Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Arjun A
authors.initials: AA
authors.lastname: Sahgal
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada. Electronic address: michael.fehlings@uhn.ca.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D001291:Attitude of Health Personnel; D015897:Comorbidity; D019538:Health Care Surveys; D015994:Incidence; D038622:Internationality; D000069471:Neurosurgeons / Q000706:statistics & numerical data*; D000072161:Orthopedic Surgeons / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D063189:Symptom Assessment
keywords: Metastatic epidural spinal cord compression; Outcomes; Predictive factors; Quality of life; Surgery; Survey; Survival