National trends in the surgical management of metastatic lung cancer to the spine using the national inpatient sample database from 2005 to 2014

Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020

BACKGROUND

Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data.

METHODS

The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated.

RESULTS

This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30 days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively.

CONCLUSION

During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.

The Fear of Surgery and Coronavirus in Patients Who Will Undergo a Surgical Intervention

PURPOSE

The aim of this study was to determine the fear of surgery and Coronavirus in patients who will undergo a surgical intervention.

DESIGN

A descriptive cross-sectional study.

METHODS

This study was carried out with 103 patients who were hospitalized in the thoracic and cardiovascular surgery departments of a university hospital between July and December 2021 and underwent elective cardiac/thoracic surgery for various indications. The Patient Information Form, Surgical Fear Questionnaire, and Coronavirus (COVID-19) Fear Scale were used to collect data. One hundred three patients were reached within the scope of the study. Data were analyzed with the Mann Whitney U and Kruskal Wallis tests and Spearman's correlation analysis in IBM SPSS (V.22.0) program.

FINDINGS

The mean age of the participants was 57.8 ± 14.0 years (19-82), 68.0% (n = 70) were male, and 78.7% (n = 81) underwent thoracic surgery. The total mean score of the patients on the Surgical Fear Scale was 26.9 ± 20.5 while the total mean score on the Coronavirus Fear Scale was 18.2 ± 7.5. A weak positive correlation was identified between the patients' total score averages on the Surgical Fear Scale and the Coronavirus Fear Scale (COVID-19) (P < .001).

CONCLUSIONS

Patients undergoing cardiothoracic surgery had a low fear of surgery and a close to moderate fear of Coronavirus. Patients' fears of surgery and Coronavirus should be determined before surgery, and psychological support should be provided to patients with high levels of fear.

Clinical Efficacy of Single-Port Thoracoscopic Lobectomy versus Three-Port Thoracoscopic Lobectomy for Lung Cancer

Objective

To evaluate the clinical efficacy of single-port thoracoscopic lobectomy versus three-port thoracoscopic lobectomy for lung cancer.

Methods

From February 2020 to February 2021, 200 lung cancer patients treated in our institution assessed for eligibility were enrolled and randomly assigned (1 : 1) to either the experimental group (single-port thoracoscopic lobectomy) or the control group (three-port thoracoscopic lobectomy). The outcomes were the eligible patients' surgical indices, pain stress indexes, and postoperative complications.

Results

The experimental group outperformed the control group in terms of incision length, postoperative drainage time, extubation time, time to get out of bed, time to analgesics administration, and postoperative pain score (P < 0.001). Compared with the control group, the experimental group reduced the intraoperative bleeding (161.98 ± 10.65 versus 179.65 ± 14.20, P < 0.001) and length of hospital stay (7.98 ± 0.56 versus 10.46 ± 1.23, P < 0.001). The operative time of the single-port thoracoscopic lobectomy was longer than that of the three-port thoracoscopic lobectomy (P < 0.001). There was no statistical difference between the two groups in the intraoperative conversion to thoracotomy and the number of lymph node dissections (P > 0.05). Postoperative pain stress indices and complication rates of the experimental group were significantly lower than those of the control group (P < 0.001).

Conclusion

Single-port thoracoscopic lobectomy can improve the perioperative indices of lung cancer patients, reduce their pain stress response, and accelerate postoperative recovery. However, its operation is difficult and time-consuming, requiring experienced surgeons for improved surgical outcomes in practice.

PROFILE OF PATIENTS WITH SPINE TUMOR OPERATED IN A SOUTH AMERICAN REFERENCE SERVICE. EPIDEMIOLOGICAL STUDY

ABSTRACT Objective: The objective was to conduct an analytical epidemiological study to understand the profile, treatment, and outcome of patients with spinal tumors in a Brazilian Quaternary Hospital of the SUS. Methods: A retrospective cohort analysis of data from the last five years was performed. It was described qualitative characteristics evaluated by absolute and relative frequencies and quantitative characteristics by sintetized measures. Associations between characteristics were verified using chi-square tests or exact tests. Results: 92 patients met the eligibility criteria. The mean age was 56.1 years (±14.7), with 48 men (52.2%) and 44 women (47.8%). The types of tumors organized in the three proposed groups had 19 multiple myelomas (20.7%), 62 metastases (67.3%), and 11 other tumors (12%). The neurological status measured through the ASIA score was A: 5.4%, B: 22.8%, C: 26.1%, D: 35.9%, E: 9.8%. Karnofsky was prevalent in the 50-70 range with 65.2%. The total hospitalization period had a mean of 22.8±18 days, preoperatively 11.9±9.2 days, and postoperatively 10.9±14 days. Karnofsky presented lower values according to the worst ASIA (p < 0.001). A total of 12 patients (13%) died during hospitalization. The total and postoperative length of stay was longer in patients who died (p = 0.002 and p < 0.001). Conclusions: This study provides epidemiological data that allow an understanding of the profile of patients with spinal tumors in the Brazilian Public Health System. The severity of the patients is higher when compared to most of the series cases in the literature. The patients with longer hospitalization stay died. Level of evidence IV; Case series.