Palliative Care Consultation Utilization Among Patient Undergoing Surgery for Metastatic Spinal Tumors

Jeffrey W Chen; Hani Chanbour; Gabriel A Bendfeldt; Lakshmi Suryateja Gangavarapu; Mohana B Karlekar; Amir M Abtahi; Byron F Stephens; Scott L Zuckerman; Silky Chotai

doi:10.1016/j.wneu.2023.07.118

Palliative Care Consultation Utilization Among Patient Undergoing Surgery for Metastatic Spinal Tumors

World Neurosurg. 2023 Oct:178:e549-e558. doi: 10.1016/j.wneu.2023.07.118. Epub 2023 Aug 1.

Authors

Jeffrey W Chen¹, Hani Chanbour², Gabriel A Bendfeldt¹, Lakshmi Suryateja Gangavarapu¹, Mohana B Karlekar³, Amir M Abtahi⁴, Byron F Stephens⁴, Scott L Zuckerman⁴, Silky Chotai⁵

Affiliations

¹ Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
² Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³ Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁴ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁵ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: silky.chotai@vumc.org.

PMID: 37532016
DOI: 10.1016/j.wneu.2023.07.118

Abstract

Objective: In patients undergoing surgery for spinal metastasis, we sought to: (1) describe patterns of palliative care consultation, (2) evaluate the factors that trigger palliative care consultation, and (3) determine the association of palliative care consultation on longer-term outcomes.

Methods: A single-center, retrospective, case-control study was conducted for patients undergoing spinal metastasis surgery from February 2010 to January 2021. The primary outcome was receiving a palliative care consultation, and the timing of consultation was divided into same hospital stay consultation, preoperative versus postoperative consultation, and early (<Postoperative day 7) versus late (≥Postoperative day 7) consultation.

Results: Of 363 patients undergoing surgery for spinal metastasis, 62 (17.0%) patients received palliative care consultation during the same hospitalization, 11 (17.7%) were preoperative, and 51 (82.2%) were postoperative. Among same-stay consultations, 32 (51.6%) were early and 30 (48.4%) were late. Palliative care consultation recipients had worse preoperative Karnofsky Performance Scale (KPS) score (P < 0.001), were more likely to have other organ metastases (P = 0.005) or cord compression (P = 0.026), had longer hospitalization (P < 0.001), and were less likely to be discharged home (P < 0.001). Patients presenting with mechanical pain were more likely to receive preoperative consults compared with postoperative (P = 0.029), and earlier compared with later consultations (P = 0.046). Regarding long-term outcomes, patients with same-stay palliative care consultation had significantly shorter overall survival (log-rank; P < 0.001), worse KPS postoperatively (P = 0.017), and worse KPS and Modified McCormick Scale at the last follow-up (P < 0.001).

Conclusions: Only 1 in 6 patients received palliative care consultation. Patients receiving same-stay palliative care consultation had more advanced local and systemic disease burden. Increased utilization of palliative care consultation in patients with spine metastasis is needed.

Keywords: Overall survival; Palliative care; Spinal metastasis; Spinal tumors.

MeSH terms

Case-Control Studies
Central Nervous System Neoplasms*
Humans
Palliative Care
Referral and Consultation
Retrospective Studies
Spinal Cord Neoplasms*
Spinal Neoplasms* / secondary