Laminectomy Versus Corpectomy for Spinal Metastatic Disease-Complications, Costs, and Quality Outcomes

• Published in: World neurosurgery Vol. 131; pp. e468 - e473
• Main Authors: Azad, Tej D, Varshneya, Kunal, Ho, Allen L, Veeravagu, Anand, Sciubba, Daniel M, Ratliff, John K
• Format: Journal Article
• Language: English
• Published: United States 01.11.2019
• Subjects: Adult; Decompression, Surgical - economics; Decompression, Surgical - methods; Female; Health Care Costs; Humans; Laminectomy - economics; Laminectomy - methods; Male; Middle Aged; Postoperative Complications - economics; Postoperative Complications - epidemiology; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spinal Neoplasms - complications; Spinal Neoplasms - secondary; Spinal Neoplasms - surgery; Corpectomy; Laminectomy; Epidural spinal cord compression; Spine metastasis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.07.206

The landmark Patchell trial established surgical decompression followed by adjuvant radiotherapy as standard-of-care for patients with spinal cord compression caused by metastatic cancer. However, little comparative evidence exists with regard to the choice of specific surgical approaches for these patients. We sought to conduct a comparative analysis of outcomes of surgical options for spinal metastatic disease. This was an epidemiologic study using national administrative data from the MarketScan database. We queried the MarketScan database (2007-2016), identifying patients with a diagnosis of spinal metastasis treated with surgical decompression (N = 1054). We used descriptive statistics and hypothesis testing to compare baseline characteristics, complications, quality metrics, and costs. We identified patients with spinal metastases undergoing laminectomy (N = 760), corpectomy (N = 193), or both combined procedures (laminectomy and corpectomy, N = 101). No significant differences in baseline demographics, follow-up time, or primary tumor histology were observed. We found a greater 30-day postoperative complication rate among patients undergoing corpectomy (P < 0.0001), driven by increased rate of postoperative anemia and pulmonary complications. Length of stay and 30-day readmission rates did not vary between surgical approaches. Total index hospitalization and 30-day payments were greatest among patients undergoing combined procedures and lowest for patients undergoing laminectomy alone. Our findings highlight distinct complication profiles and quality outcomes associated with selection of surgical approach for patients with spinal metastases. These findings must be interpreted with a clear understanding of the limitations.