title: Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site infection.
abstract: BACKGROUND
  Patients with metastatic spinal tumours have a limited prognosis. Surgical complications that may result in prolonged hospitalization or readmission are highly undesirable. Surgical site infection (SSI) is one such complication, which can, in extreme cases, lead to death.
  
  
  OBJECTIVE
  To assess the impact of SSI on patient survival after surgery for spinal metastases.
  
  
  METHODS
  Demographic, operative, and survival data were collected on 152 patients undergoing surgery for spinal metastasis at a large UK tertiary referral centre. American Society of Anesthesiologists (ASA) grade and the Revised Tokuhashi Score (RTS) were determined as measures of health status and prognosis, respectively, at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival.
  
  
  RESULTS
  Seventeen patients (11.2%) experienced SSI. Overall, median survival time from operation was 262 days (95% confidence interval: 190-334 days) and 12-month survival was 42.1%. RTS (hazard ratio: 0.82; 95% confidence interval: 0.76-0.89; P < 0.001) and ASA grade (1.37; 1.03-1.82; P=0.028) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI (P=0.075).
  
  
  CONCLUSIONS
  Twelve-month survival in patients undergoing surgery for spinal metastasis is ∼42%. RTS and ASA scores may be used as indicators of patient survival either in combination or individually. Whereas SSI has some negative impact on survival, a larger study sample would be needed to confirm whether this is statistically significant.
authors.affiliation: Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK; Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. Electronic address: ross.atkinson@manchester.ac.uk.
authors.forename: R A
authors.initials: RA
authors.lastname: Atkinson
authors.affiliation: Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: B
authors.initials: B
authors.lastname: Davies
authors.affiliation: Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Jones
authors.affiliation: Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: D
authors.initials: D
authors.lastname: van Popta
authors.affiliation: School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ousey
authors.affiliation: School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.
authors.forename: J
authors.initials: J
authors.lastname: Stephenson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000401:mortality*; D016019:Survival Analysis; D062606:Tertiary Care Centers; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Metastasis; Spine; Surgical site infection; Survival