Clinical Outcome Differences in the Treatment of Impending Versus Completed Pathological Long-Bone Fractures
| Autor: | Neal D Kapoor, Peter K Twining, Joseph H. Schwab, Santiago A. Lozano-Calderon, Erik T. Newman, Michiel E.R. Bongers, Stein J. Janssen, Olivier Q. Groot, Jorrit-Jan Verlaan, Kevin A. Raskin, Amanda Lans |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Blood transfusion Databases Factual medicine.medical_treatment Bone Neoplasms Cohort Studies McNemar's test medicine Humans Orthopedics and Sports Medicine Pathological Survival rate Aged Retrospective Studies Proportional hazards model business.industry Mortality rate General Medicine Perioperative Middle Aged Surgery Survival Rate Fractures Spontaneous Treatment Outcome Propensity score matching Female business |
| Zdroj: | Journal of Bone and Joint Surgery. 104:307-315 |
| ISSN: | 1535-1386 0021-9355 |
| DOI: | 10.2106/jbjs.21.00711 |
| Popis: | BACKGROUND The outcome differences following surgery for an impending versus a completed pathological fracture have not been clearly defined. The purpose of the present study was to assess differences in outcomes following the surgical treatment of impending versus completed pathological fractures in patients with long-bone metastases in terms of (1) 90-day and 1-year survival and (2) intraoperative blood loss, perioperative blood transfusion, anesthesia time, duration of hospitalization, 30-day postoperative systemic complications, and reoperations. METHODS We retrospectively performed a matched cohort study utilizing a database of 1,064 patients who had undergone operative treatment for 462 impending and 602 completed metastatic long-bone fractures. After matching on 22 variables, including primary tumor, visceral metastases, and surgical treatment, 270 impending pathological fractures were matched to 270 completed pathological fractures. The primary outcome was assessed with the Cox proportional hazard model. The secondary outcomes were assessed with the McNemar test and the Wilcoxon signed-rank test. RESULTS The 90-day survival rate did not differ between the groups (HR, 1.13 [95% CI, 0.81 to 1.56]; p = 0.48), but the 1-year survival rate was worse for completed pathological fractures (46% versus 38%) (HR, 1.28 [95% CI, 1.02 to 1.61]; p = 0.03). With regard to secondary outcomes, completed pathological fractures were associated with higher intraoperative estimated blood loss (p = 0.03), a higher rate of perioperative blood transfusions (p = 0.01), longer anesthesia time (p = 0.04), and more reoperations (OR, 2.50 [95% CI, 1.92 to 7.86]; p = 0.03); no differences were found in terms of the rate of 30-day postoperative complications or the duration of hospitalization. CONCLUSIONS Patients undergoing surgery for impending pathological fractures had lower 1-year mortality rates and better secondary outcomes as compared with patients undergoing surgery for completed pathological fractures when accounting for 22 covariates through propensity matching. Patients with an impending pathological fracture appear to benefit from prophylactic stabilization as stabilizing a completed pathological fracture seems to be associated with increased mortality, blood loss, rate of blood transfusions, duration of surgery, and reoperation risk. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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