Perioperative Complications of Spinal Metastases Surgery

The incidence of symptomatic spinal metastasis has increased due to treatment improvements and longer patient survival. More patients with spinal tumors are choosing operative treatment with an associated increased rate of perioperative complications. Operative metastatic disease treatment complication rates have also increased with overall rates ranging from 5.3% to 76.20%. The common surgical-related complications are iatrogenic dural injury and wound complications. The most common postoperative medical complications are delirium, pneumonia, and deep vein thrombosis. Risk factors for perioperative complications after spinal metastatic surgery include older age, multilevel of spinal metastases, preoperative irradiation, low preoperative Karnofsky Performance Score (10-40) and multiple comorbidities. Charlson Comorbidity Index and New England Spinal Metastasis Score were significant predictor of 30-day complications. The reoperation rate is 10.7%, and the reoperation is most commonly performed in the same admission. In addition, the 30-day mortality rate in this patient population is ∼7% (0.9%-13%) and is influenced by the type of cancer, disease burden, and patient comorbidities. We reviewed the prevalence and risk factors of common perioperative complications that occur with surgical treatment of metastatic spine disease, in an effort to guide the spine surgeon in anticipating and potentially avoiding these complications.