ASO Author Reflections: Readmission-Free Survival: A Novel Clinical and Quality Outcome Measure for Metastatic Spine Tum
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Readmission-Free Survival: A Novel Clinical and Quality Outcome Measure for Metastatic Spine Tumor Surgical Patients Naresh Kumar, FRCS Ed., FRCS (Orth & Trauma), DNB (Orth) Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
PAST Clinical outcomes commonly assessed after metastatic spine tumor surgery (MSTS) include 30-day complications and mortality, recurrence-free survival (RFS), and overall survival (OS).1,2 However, these outcomes cannot be considered as true survival metrics because none considers all the key patient, treatment, and disease-related factors. Furthermore, they may not clearly reflect the quality of life (QoL) experienced by patients after MSTS. On the contrary, unplanned hospital readmissions (UHRs) after MSTS are important indicators of the poor general condition of the patient, aggressive disease, inappropriateness of treatment approach, poor treatment outcomes, and reduced QoL. The incidence of UHR is considerably high after MSTS.3 Therefore, survival free from UHR may serve as a ‘‘true integrated index’’ and may be a more optimal outcome indicator for these patients. PRESENT Survival free from UHR, or readmission-free survival (ReAFS), is a novel concept, defined as ‘‘the time duration between hospital discharge after index operation and first UHR or death.’’ An ideal ReAFS should mean the absence of UHR until death, which equals the remaining life expectancy of the patient after MSTS.4 This novel concept is different from RFS. As an integrated index, ReAFS is
Ó Society of Surgical Oncology 2020 First Received: 11 November 2020 Accepted: 11 November 2020 N. Kumar, FRCS Ed., FRCS (Orth & Trauma), DNB (Orth) e-mail: [email protected]
influenced by patient, treatment, and disease-related factors, whereas RFS is primarily dependent on disease and treatment factors such as primary tumor type and the nature of the multidisciplinary treatment approach used for tumor control and is less likely to be influenced by patient factors such as general condition and functional status.5 Most studies on UHRs of MSTS patients have focused on readmission within 30-days after index surgery and its influencing factors,6 whereas very limited studies have analyzed UHRs within 90 days or beyond the 90-day period after MSTS.3,7 Therefore, our retrospective study analyzed the data from 266 consecutive patients who underwent MSTS between 2005 and 2016 to identify factors influencing ReAFS up to 2 years or death after index MSTS. The final analysis included 230 patients. The multivariate analysis showed that a hemoglobin level of 12 g/dL or higher; an Eastern Cooperative Oncology Group (ECOG) score of 2 or lower; primary prostate, breast, and hematologic cancers; a comorbidity score of 3 or lower; absence of preoperative radiotherapy; and a shorter postoperative hospital stay significantly prolonged the ReAFS. This is the first study to present the concept of ReAFS as a novel outcome measure that can compare or even excel the com
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