Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!

A. Amelot, L. Balabaud, D. Choi, Z. Fox, H. A. Crockard, T. Albert, C. M. Arts, J. M. Buchowski, C. Bunger, C. K. Chung, M. H. Coppes, B. Depreitere, M. G. Fehlings, J. Harrop, N. Kawahara, E. S. Kim, C. S. Lee, Y. Leung, Z. J. Liu, J. A. Martin-BenllochE. M. Massicotte, B. Meyer, F. C. Oner, W. Peul, N. Qureshi, Y. Tokuhashi, K. Tomita, C. Ulbricht, J. J. Verlaan, M. Wang, C. Mazel

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. Purpose: We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. Study Design: We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. Patient Sample: There were 1,266 patients recruited between March 2001 and October 2014. Outcome Measures: Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. Methods: We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: 80 years. Results: Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients 80 years old. Conclusions: Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - Feb 20 2015
Externally publishedYes

Fingerprint

Spine
Neoplasms
Nervous System
Neoplasm Metastasis
Survival Rate
Multicenter Studies
Emergencies
Age Groups
Quality of Life
Outcome Assessment (Health Care)
Prospective Studies
Therapeutics
Palliative Care
Demography
Delivery of Health Care
Survival
Incidence

Keywords

  • Elderly
  • Emergency
  • Neurologic prognosis
  • Quality of life
  • Scheduled surgery
  • Spine compression
  • Spine metastasis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Amelot, A., Balabaud, L., Choi, D., Fox, Z., Crockard, H. A., Albert, T., ... Mazel, C. (Accepted/In press). Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery! Spine Journal. https://doi.org/10.1016/j.spinee.2015.07.440

Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery! / Amelot, A.; Balabaud, L.; Choi, D.; Fox, Z.; Crockard, H. A.; Albert, T.; Arts, C. M.; Buchowski, J. M.; Bunger, C.; Chung, C. K.; Coppes, M. H.; Depreitere, B.; Fehlings, M. G.; Harrop, J.; Kawahara, N.; Kim, E. S.; Lee, C. S.; Leung, Y.; Liu, Z. J.; Martin-Benlloch, J. A.; Massicotte, E. M.; Meyer, B.; Oner, F. C.; Peul, W.; Qureshi, N.; Tokuhashi, Y.; Tomita, K.; Ulbricht, C.; Verlaan, J. J.; Wang, M.; Mazel, C.

In: Spine Journal, 20.02.2015.

Research output: Contribution to journalArticle

Amelot, A, Balabaud, L, Choi, D, Fox, Z, Crockard, HA, Albert, T, Arts, CM, Buchowski, JM, Bunger, C, Chung, CK, Coppes, MH, Depreitere, B, Fehlings, MG, Harrop, J, Kawahara, N, Kim, ES, Lee, CS, Leung, Y, Liu, ZJ, Martin-Benlloch, JA, Massicotte, EM, Meyer, B, Oner, FC, Peul, W, Qureshi, N, Tokuhashi, Y, Tomita, K, Ulbricht, C, Verlaan, JJ, Wang, M & Mazel, C 2015, 'Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!', Spine Journal. https://doi.org/10.1016/j.spinee.2015.07.440
Amelot, A. ; Balabaud, L. ; Choi, D. ; Fox, Z. ; Crockard, H. A. ; Albert, T. ; Arts, C. M. ; Buchowski, J. M. ; Bunger, C. ; Chung, C. K. ; Coppes, M. H. ; Depreitere, B. ; Fehlings, M. G. ; Harrop, J. ; Kawahara, N. ; Kim, E. S. ; Lee, C. S. ; Leung, Y. ; Liu, Z. J. ; Martin-Benlloch, J. A. ; Massicotte, E. M. ; Meyer, B. ; Oner, F. C. ; Peul, W. ; Qureshi, N. ; Tokuhashi, Y. ; Tomita, K. ; Ulbricht, C. ; Verlaan, J. J. ; Wang, M. ; Mazel, C. / Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!. In: Spine Journal. 2015.
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title = "Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!",
abstract = "Background: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. Purpose: We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. Study Design: We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. Patient Sample: There were 1,266 patients recruited between March 2001 and October 2014. Outcome Measures: Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. Methods: We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: 80 years. Results: Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3{\%} in the >80, 23.9{\%} in the 70-80, and 17.9{\%} for patients 80 years old. Conclusions: Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.",
keywords = "Elderly, Emergency, Neurologic prognosis, Quality of life, Scheduled surgery, Spine compression, Spine metastasis",
author = "A. Amelot and L. Balabaud and D. Choi and Z. Fox and Crockard, {H. A.} and T. Albert and Arts, {C. M.} and Buchowski, {J. M.} and C. Bunger and Chung, {C. K.} and Coppes, {M. H.} and B. Depreitere and Fehlings, {M. G.} and J. Harrop and N. Kawahara and Kim, {E. S.} and Lee, {C. S.} and Y. Leung and Liu, {Z. J.} and Martin-Benlloch, {J. A.} and Massicotte, {E. M.} and B. Meyer and Oner, {F. C.} and W. Peul and N. Qureshi and Y. Tokuhashi and K. Tomita and C. Ulbricht and Verlaan, {J. J.} and M. Wang and C. Mazel",
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T1 - Surgery for metastatic spine tumors in the elderly. Advanced age is not a contraindication to surgery!

AU - Amelot, A.

AU - Balabaud, L.

AU - Choi, D.

AU - Fox, Z.

AU - Crockard, H. A.

AU - Albert, T.

AU - Arts, C. M.

AU - Buchowski, J. M.

AU - Bunger, C.

AU - Chung, C. K.

AU - Coppes, M. H.

AU - Depreitere, B.

AU - Fehlings, M. G.

AU - Harrop, J.

AU - Kawahara, N.

AU - Kim, E. S.

AU - Lee, C. S.

AU - Leung, Y.

AU - Liu, Z. J.

AU - Martin-Benlloch, J. A.

AU - Massicotte, E. M.

AU - Meyer, B.

AU - Oner, F. C.

AU - Peul, W.

AU - Qureshi, N.

AU - Tokuhashi, Y.

AU - Tomita, K.

AU - Ulbricht, C.

AU - Verlaan, J. J.

AU - Wang, M.

AU - Mazel, C.

PY - 2015/2/20

Y1 - 2015/2/20

N2 - Background: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. Purpose: We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. Study Design: We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. Patient Sample: There were 1,266 patients recruited between March 2001 and October 2014. Outcome Measures: Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. Methods: We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: 80 years. Results: Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients 80 years old. Conclusions: Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.

AB - Background: With recent advances in oncologic treatments, there has been an increase in patient survival rates and concurrently an increase in the number of incidence of symptomatic spinal metastases. Because elderly patients are a substantial part of the oncology population, their types of treatment as well as the possible impact their treatment will have on healthcare resources need to be further examined. Purpose: We studied whether age has a significant influence on quality of life and survival in surgical interventions for spinal metastases. Study Design: We used data from a multicenter prospective study by the Global Spine Tumor Study Group (GSTSG). This GSTSG study involved 1,266 patients who were admitted for surgical treatments of symptomatic spinal metastases at 22 spinal centers from different countries and followed up for 2 years after surgery. Patient Sample: There were 1,266 patients recruited between March 2001 and October 2014. Outcome Measures: Patient demographics were collected along with outcome measures, including European Quality of Life-5 Dimensions (EQ-5D), neurologic functions, complications, and survival rates. Methods: We realized a multicenter prospective study of 1,266 patients admitted for surgical treatment of symptomatic spinal metastases. They were divided and studied into three different age groups: 80 years. Results: Despite a lack of statistical difference in American Society of Anesthesiologists (ASA) score, Frankel neurologic score, or Karnofsky functional score at presentation, patients >80 years were more likely to undergo emergency surgery and palliative procedures compared with younger patients. Postoperative complications were more common in the oldest age group (33.3% in the >80, 23.9% in the 70-80, and 17.9% for patients 80 years old. Conclusions: Surgeons should not be biased against operating elderly patients. Although survival rates and neurologic improvements in the elderly patients are lower than for younger patients, operating the elderly is compounded by the fact that they undergo more emergency and palliative procedures, despite good ASA scores and functional status. Age in itself should not be a determinant of whether to operate or not, and operations should not be avoided in the elderly when indicated.

KW - Elderly

KW - Emergency

KW - Neurologic prognosis

KW - Quality of life

KW - Scheduled surgery

KW - Spine compression

KW - Spine metastasis

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