Pulmonary complications linked to mortality in bone metastasis surgery

Surgery has a 3% mortality rate, but 74% of deceased patients had pulmonary complications.

A study highlighting low perioperative morbidity for the surgical treatment of bone metastasis also points to pulmonary complications as risk factors for death with these procedures.

In a retrospective review of 899 consecutive surgeries for metastatic bone disease, investigators found a 15% overall complication rate during the hospitalization period and that 36% of all complications were related to pulmonary conditions. Moreover, the investigators found a 3% overall mortality rate, and that 74% of the deaths resulted from pulmonary complications.

"Careful assessment of risk factors and preoperative optimization, whenever possible, is encouraged," Anne Normand, MD, said during her presentation at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. "The pulmonary complications were associated with an increased risk of mortality. Surgical intervention, overall, can be performed safely in most of these patients."

According to Normand, a pathologic fracture is a prognostic factor for perioperative complications, but not for mortality. She encourages surgeons to optimize medical comorbidities prior to surgical stabilization for high-risk patients.

Normand and colleagues studied patients who underwent surgical treatment for metastatic disease of the extremities and pelvis at a single institution. The patients had various preoperative diagnoses, but most had renal cell, breast, lung or prostate cancer. The surgical sites also varied, but most occurred at the humeral shaft, proximal femur, proximal humerus or the pelvis. The group had a median age of 57 years and 48% presented with pathologic fractures.

Of the 15% perioperative complications, "Medical complications were more common than surgical complications by far. Of those, pulmonary complications were the most common, consisting primarily of pneumonia and respiratory failure," Normand said, noting 6% of patients had pulmonary problems.

Other medical complications included deep venous thrombosis, myocardial infarction and stroke.

"Interestingly, only one fat embolus was proven in this case series," she said.

Only 13 patients had surgical complications, which accounted for 10% of all complications. Less than 1% of these required reoperation. "The complications that underwent reoperation included deep infection, durotomy, flap failure, dislocation and periprosthetic fracture," Normand said.

For more information:
Anne Normand, MD, can be reached at Saint Mary's Duluth Clinic, 400 East Third St, Duluth, MN 55805; 218-786-3520. She has no direct financial interest to disclose.

Reference:
Normand A, Lin PP, Lewis VO, et al. Peri-operative morbidity in the treatment of pelvic and extremity bone metastasis. #260. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18, 2007. San Diego.