LAUSR

STUDY DESIGN Database Analysis. OBJECTIVE To evaluate complications and mortality in patients undergoing surgical management of extradural spinal tumors in New York State. SUMMARY OF BACKGROUND DATA Metastatic spine surgery has a high rate of complications but most studies are limited to single institutions. METHODS The Statewide Planning and Research Cooperative System (SPARCS) was used to identify patients with extradural spinal tumors undergoing surgery in New York State from 2006 to 2015. Bivariate and multivariate logistic regression analysis were used to estimate outcomes. RESULTS 4,767 patients were identified, the majority of patients were male and white a median age of 61. The complication rate was 17.6% and the mortality rate within 30 days of discharge was 12.2%. Multivariate analysis showed the odds of complications were higher in males compared to females (Odds Ratio [OR]: 1.27; 95% Confidence Interval [CI]: 1.05 - 1.52, p = 0.01), and patients on Medicaid compared to patients on private insurance (OR: 1.42; 95% CI: 1.03 - 1.96, p = 0.03). Analysis of hospital characteristics showed lower volume hospitals (OR 1.48; 95% CI: 1.03 - 2.13, p-value = 0.03), and teaching hospitals (OR: 1.47; 95% CI: 1.03 - 2.09, p = 0.04), have higher odds of complications compared to high volume hospitals and non-teaching hospitals. Multivariate analysis showed higher odds of mortality within 30 days of discharge in patients of older age (OR: 1.02; 95% CI: 1.01 - 1.03, p-value = 0.001), low volume hospitals compared to high volume hospitals (OR: 1.36; 95% CI: 1.09 - 1.79, p-value = 0.02), hospitals with low bed size compared to high bed size (OR: 1.43; 95% CI: 1.12 - 1.83, p-value = 0.01) and urban hospitals compared to rural hospitals (OR: 3.04; 95% CI: 2.03 - 4.56, p-value = 0.001). CONCLUSIONS Low volume hospitals are associated with complications and mortality in patients with metastatic spine disease. LEVEL OF EVIDENCE 3.