Perioperative Risk Factors for Thirty-Day Morbidity and Mortality in the Resection of Extradural Thoracic Spine Tumors.

OBJECTIVE

Resection of epidural thoracic spine tumors is uniquely challenging owing to the dangers posed by the surrounding anatomy and the unforgiving nature of the thoracic spinal cord. We assessed the preoperative and postoperative risk factors for 30-day morbidity and mortality in patients undergoing resection of these tumors.

METHODS

Adults who underwent laminectomy for excision of thoracic spine tumors from 2011 to 2014 were included. The demographic data and medical comorbidities and major morbidities and mortalities within 30 postoperative days were collected and assessed using multivariate binary logistic analysis.

RESULTS

The database search yielded 616 patients, of whom 232 (37.7%) were female. Overall, complications within 30 days of surgery occurred in 322 patients (52.3%). Of the 616 patients, 64 (10.4%) died within 30 days of surgery. Smoking history was associated with significantly greater 30-day morbidity (P = 0.019), as was preoperative anemia for females (P = 0.003) and preoperative hypoalbuminemia (P < 0.0001), with the need for preoperative blood transfusion also leading to greater morbidity (P = 0.001). The presence of preoperative dyspnea and congestive heart failure increased the risk of complications (P = 0.001). Preoperative hypoalbuminemia (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.8-7.0), dependent functional status (OR, 3.6; 95% CI, 1.7-7.6), and bleeding disorder (OR, 7.1; 95% CI, 2.5-20.1) were significantly associated with 30-day mortality. Deep vein thrombosis/pulmonary embolism, nonthrombotic pulmonary complications, and blood transfusions were common post- and perioperative complications.

CONCLUSIONS

Excision of epidural thoracic spinal tumors carries a high complication rate. The present series has revealed distinct preoperative and postoperative factors that contribute to 30-day morbidity and mortality for tumors in this region, many of which are amenable to careful preoperative management.