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CORR Insights®: Thirty-day Postoperative Complications After Surgery for Metastatic Long Bone Disease Are Associated With Higher Mortality at 1 Year.

The primary objectives in the management of most patients with osseous metastases are to reduce pain, increase mobility, and improve quality of life. During the past several years, studies have reported a clear benefit to the use of anti-resorptive therapy in preventing skeletal-related events (pathologic fracture, use of radiation therapy or prophylactic stabilization, spinal cord compression, or hypercalcemia of malignancy) in such patients [4, 13]. As improvements in systemic therapy help patients with osseous metastases to live longer with their disease, the stabilization of long bones becomes increasingly important. Although most long-bone stabilization procedures are palliative, prophylactic stabilizations are associated with longer patient survival [12], and with lower rates of early postoperative complications [3] compared with postfracture stabilization. Studies have demonstrated associations between several factors, including hypoalbuminemia, Katagiri tumor type [7], and duration of survival after surgical treatment of appendicular skeletal metastases [5, 8]. The PathFX system is a widely available prognostic tool for predicting the probability of survival with bone metastases by using a Bayesian network; the system has been validated in numerous global populations [5, 6, 11]. PathFX identifies a key role for Katagiri grouping, as well as for several laboratory values [5]. Interestingly, the surgeon’s estimation of survival duration is possibly the most predictive variable in models of prognostication [10]. Perhaps experienced oncologic surgeons can synthesize patientand disease-specific information and make informed judgments about the health of a potential surgical patient, which may influence treatment decisions. The current analysis helps inform a more objective assessment of perioperative risk in this complex patient population. In the current analysis, Bindels and colleagues [1] identify potentially modifiable comorbidities associated with early postoperative complications and demonstrate the association of these early postoperative complications with 1-year mortality. In using the Clavien-Dindo classification of adverse events, the authors noted complications in 31% of surgically treated patients within 30 days after surgery. Although many of the identified comorbidities are outside the control of patients and clinicians (lesion location, primary malignancy type), others may be modifiable, particularly nutritional insufficiency and laboratory abnormalities.