Our next speaker is Dr. Shanker, who will speak on the topic of predictive factors leading to readmission within 30 days in patients undergoing surgery for spinal metastases. Thanks. All right, thank you. And I'd like to thank the scientific committee for inviting us to present our recent work and Mass General Hospital for how patients are doing following their surgery for spinal metastases. These are the disclosures for the authors. By way of a brief background, spinal metastases and skeletal metastases are very common in patients with cancer. Up to 90% of patients on autopsy studies have some form of lesion in the bones, with 10% of patients during their natural history presenting with symptomatic spinal mets during their disease course. The treatment of primary disease involves local resection, whereas metastatic disease involves consideration for palliative surgery, radiation therapy, and systemic agents. And today I'll be discussing how patients are doing after their surgical intervention for the spine. One thing that's borne out in the recent literature is that patients who undergo surgery for spine oncologic reasons have a relatively high readmission rate. And this is in comparison to patients who undergo intervention for degenerative spine or other reasons. And these readmission rates range on the order of 10 to 14%. I'd also like to highlight that while these are recent studies, medical oncology is moving at light speed recently. So things are continuing to change even since these papers have come out. And to highlight that, I'll just show two cancer subtypes with renal cell carcinoma having dramatic improvements in overall survival with the advent of new FDA-approved therapies targeting multiple pathways, which have resulted in dramatic changes in survival of approximately a year to over two years in the span of a decade. Melanoma has similarly seen significant improvements in outcomes with the advent of not only targeted therapies against BRAF and MEK, but also immunotherapy, resulting in significant improvements in survival. So what does this mean for us? When we think about patients and their surgical interventions, we have a really hard time, even in the best of frameworks, to figure out where are patients in their systemic disease. And one question, especially as medical oncology moves so fast, is at what point in the disease course are patients presenting to us with spinal metastases, and how are these affecting readmission rates? So for this, we did a retrospective cohort study of 166 consecutive patients presenting between 2011 and 2017, trying to push as far as possible to the modern era. These are the preoperative baseline characteristics. Of note, most of these patients presented with lesions in the thoracic spine, and most of them presenting with axial pain. I'd like to highlight that in terms of previous therapies, the vast majority of patients had received some form of systemic chemotherapy, including targeted therapies and immunotherapy, and that most of these patients presented with oligometastatic disease of the spine, as well as presence of other visceral meds. Primary site of disease was predominantly lung and renal, with melanoma making up a significant portion as well. The factors associated with readmission, we noted a pretty high rate of readmission, which surprised us at 28 percent within 30 days, which is definitely different than what has been recently published. But what we noted is that most of these readmissions were occurring for medical reasons, not associated with the surgery itself. Nearly three quarters, more than three quarters are for medical reasons, largely in part due to their disease progression or other medical etiologies, which in some way or part were due to their oncologic process as well. With only a quarter of these patients being readmitted for issues directly related to the surgery itself, including pain and wound healing issues. I just, and these rates are in line with what had been previously reported. And I'd just like to highlight that we have been engaging palliative care early on for perioperative pain management and plastic surgery for assistance at the time of index, of the index surgery. In terms of the multivariate regression analysis, we found that more than three levels of metastatic disease were involved, were predictive of readmission, and that chemotherapy given within 30 days was also predictive. And these are the factors that were not predictive of readmission. So in sum, the vast majority of postoperative readmissions are due to progression of the oncologic disease, and that in supporting that is that the advanced nature of disease and recent history of chemotherapy are predictive of readmission, which leads us to the following hypothesis, which needs to be fleshed out more in granular detail, which is that patients may now be presenting with spinal metastasis at an even more advanced stage of disease following multiple treatment failures. And just to point, give one piece of data that may be indicative of that is something that we had published a year ago, which indicated that patients with metastatic melanoma who had already received immunotherapy had a far shorter overall survival postoperatively than those who were immunotherapy naive. And that this type of relationship to treatment failures will be important going forward. Thank you.

predictive factors

readmission

30 days

spinal metastases

surgery