title: Readmissions After Surgical Resection of Metastatic Tumors of the Spine at a Single Institution.
abstract: BACKGROUND
  Surgical management of spinal metastasis is complex and can be associated with significant postoperative morbidity. Analyzing readmission rates may serve as a proxy for postoperative morbidity and functional decline, allowing patients and physicians to make informed decisions about treatment.
  
  
  METHODS
  Retrospective analysis was performed of patients with metastatic spine disease surgically treated at a tertiary center from 2003 to 2012. Patients with primary lung cancer, breast cancer, kidney cancer, bone marrow cancer, prostate cancer, gynecologic cancer, and melanoma were analyzed. Primary and secondary outcome variables were readmissions and overall survival. Multivariate Cox proportional hazards model was used to identify independent factors associated with readmissions.
  
  
  RESULTS
  There were 159 patients analyzed. Lung, breast, and kidney represented the most common primary cancer sites, accounting for 22%, 19.5%, and 16.4%. Of patients, 56.6% had at least 1 readmission, with a 30-day readmission rate of 13.8% and 1-year readmission rate of 47.2%. Readmissions were for surgical complications (26.7%), oncologic disease progression (33.7%), and other medical reasons (36.7%). Patients with colorectal cancer had the highest number of readmissions. Patients with melanoma had more readmissions over the course of their limited postoperative survival. Overall mortality was 59.1%, with a median survival of 15.1 months. Multivariate analysis revealed age >60 years and previous radiation of the spine increased the likelihood of readmission.
  
  
  CONCLUSIONS
  Readmissions provide an important window into understanding postoperative morbidity among patients with metastatic disease of the spine. This study offers an important starting point for understanding the nuances of patients' postoperative outcomes.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Abu-Bonsrah
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: rory@jhmi.edu.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kosztowski
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.affiliation: Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D062606:Tertiary Care Centers / Q000639:trends*
keywords: Metastasis; Outcomes; Readmission; Spine; Surgery