title: Risk factors for same-admission mortality after pathologic fracture secondary to metastatic cancer.
abstract: The skeleton is the third most common site of cancer metastases. Approximately 10 % of patients with bone metastases will develop a pathologic fracture, with significant associated morbidity and mortality. The purpose of this study was to identify risk factors for same-admission mortality after pathologic fractures secondary to metastatic cancer.
  
  
  
  The Nationwide Inpatient Sample database was queried from 2002 to 2013 for hospitalized patients with diagnoses of pathologic fracture and a primary cancer at high risk for skeletal metastasis. Univariate and multivariate analyses were performed to determine risk factors associated with same-admission mortality after fracture.
  
  
  
  A total of 371,163 patients were identified. The spine was the most common site of pathologic fracture (68.0 %) followed by lower extremity (25.0 %) and upper extremity (8.7 %). The following factors were independently associated with increased mortality (p < 0.001): cancer of lung or unspecified location; fracture of upper or lower extremity; male gender; age ≥65; non-Medicare insurance; coexisting congestive heart failure, chronic pulmonary disease, renal failure, or liver disease; and postoperative surgical site infection, acute myocardial infarction, pulmonary embolism, or pneumonia. Closed reductions were associated (p < 0.001) with increased mortality while open or percutaneous surgical treatments were protective (p < 0.001) against mortality.
  
  
  
  Pathologic fractures are a devastating consequence of metastatic bone disease, contributing significantly to morbidity and mortality. Numerous demographic and medical factors are associated with increased same-admission mortality. This data is useful for counseling patients with skeletal metastatic disease and should be taken into consideration when conducting routine skeletal surveillance in patients with metastatic cancer.
authors.affiliation: Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA. nkbehnke@uabmc.edu.
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Behnke
authors.affiliation: Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
authors.forename: Dustin K
authors.initials: DK
authors.lastname: Baker
authors.affiliation: Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
authors.forename: Shin
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Niemeier
authors.affiliation: Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
authors.forename: Shawna L
authors.initials: SL
authors.lastname: Watson
authors.affiliation: Department of Surgery, Division of Orthopaedics, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Ponce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary*; D016208:Databases, Factual; D005260:Female; D005598:Fractures, Spontaneous / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D012307:Risk Factors
keywords: Musculoskeletal oncology; NIS; National Inpatient Sample; Neoplasm metastasis; Orthopedics; Spontaneous fractures