Do Postoperative Outcomes of Surgical Treatment for Spinal Metastasis Differ by Institutional Function?: Analysis of a Nationwide Administrative Database in Japan.

Abstract

Retrospective comparative study. To investigate the impact of institutional function (cancer center and surgical volume for spine surgery) on in-hospital outcomes after surgical treatment for spinal metastasis using a nationwide administrative database. Multidisciplinary approaches to bone metastasis have become common in Japan, especially in cancer centers. However, whether treatment outcomes for spinal metastasis surgery differ by institutional function remains controversial. Data of patients who underwent surgical procedures for spinal metastasis between 2012 and 2020 were extracted from the Diagnosis Procedure Combination database. In-hospital outcomes included in-hospital mortality, 30-day mortality, length of stay until discharge home, postoperative complications, and unfavorable ambulatory status. Univariate and multivariate analyses were performed to investigate the association between cancer center/surgical volume and each outcome while adjusting for potential confounders. A total of 10,320 patients were included in this study. Among them, 5261 patients were treated at cancer centers. The median annual surgical volume for spine surgery was 166 cases. The 30-day mortality was lower in cancer centers than in noncancer centers [odds ratio (OR): 0.841, 95% CI: 0.709-0.999, P=0.0483] and in high-volume hospitals for spine surgery than in low-volume hospitals (OR per 50 cases: 0.958, 95% CI: 0.928-0.990, P=0.0101). The length of stay until discharge home, postoperative complications, and postoperative unfavorable ambulatory status did not differ by cancer center or surgical volume. The short-term mortality was lower in cancer centers or high-volume hospitals, whereas postoperative complications and ambulatory outcomes did not differ by institutional function. A deeper understanding of the multidisciplinary approaches or processes of care adopted at these institutions might be important to deliver similar outcomes in other hospitals to patients with spinal metastasis. Level III.