Risk Factors for Thirty-Day Morbidity and Mortality in Extradural Lumbar Spine Tumor Resection

• Published in: World neurosurgery 2018-06, Vol.114, p.e1101-e1106
• Main Authors: Sarkiss, Christopher A., Hersh, Eliza H., Ladner, Travis R., Lee, Nathan, Kothari, Parth, Lakomkin, Nikita, Caridi, John M.
• Format: Article
• Language: English
• Subjects: ACS-NSQIP; Extradural; Lumbar spine; Spinal metastasis; Spinal tumor
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.03.155

Epidural tumors in the lumbar spine represent a unique cohort of lesions with individual risks and challenges to resection. Knowledge of modifiable risk factors are important in minimizing postoperative complications. To determine the risk factors for 30-day morbidity and mortality in patients undergoing extradural lumbar tumor resection. A retrospective study of prospectively collected data using the American College of Surgeons National Quality Improvement Program database was performed. Adults who underwent laminectomy for excision of lumbar spine tumors between 2011 and 2014 were included in the study. Demographics and medical comorbidities were collected, along with morbidities and mortalities within 30 postoperative days. A multivariate binary logistic analysis of these clinical variables was performed to determine covariates of morbidity and mortality. The database search yielded 300 patients, of whom 118 (39.3%) were female. Overall, complications within 30 days of surgery occurred in 102 (34%) patients. Significant risk factors for morbidity included preoperative anemia (P < 0.0001), the need for preoperative blood transfusion (P = 0.034), preoperative hypoalbuminemia (P = 0.002), American Society of Anesthesiologists score 3 or 4 (P = 0.0002), and operative time >4 hours (P < 0.0001). Thirty-day mortality occurred in 15 (5%) patients and was independently associated with preoperative anemia (odds ratio 3.4, 95% confidence interval 1.8–6.5) and operative time >4 hours (odds ratio 2.6, 95% confidence interval 1.1–6.0). Excision of epidural lumbar spinal tumors carries a relatively high complication rate. This series reveals distinct risk factors that contribute to 30-day morbidity and mortality, which may be optimized preoperatively to improve surgical safety. •This if the first study to independently examine the risks of extradural lumbar tumor resection.•Excision of these tumors carries a relatively high 30-day complication rate (34%).•Excision of these tumors carries a relatively high 30-day mortality rate (5%).