Impact of Multidisciplinary Intraoperative Teams on Thirty-Day Complications After Sacral Tumor Resection

Andrew Schilling, Zach Pennington, Jeff Ehresman, Andrew Hersh, Siddhartha Srivastava, Bethany Hung, David Botros, Ethan Cottrill, Daniel Lubelski, C. Rory Goodwin, Sheng Fu Lo, Daniel M. Sciubba

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the impact of multidisciplinary intraoperative teams on surgical complications in patients undergoing sacral tumor resection. Methods: We reviewed all patients with primary or metastatic sacral tumors managed at a single comprehensive cancer center over a 7-year period. Perioperative complication rates were compared between those treated by an unassisted spinal oncologist and those treated with the assistance of at least 1 other surgical specialty. Statistical analysis involved univariable and stepwise multivariable logistic regression models to identify predictors of multidisciplinary management and 30-day complications. Results: A total of 107 patients underwent 132 operations for sacral tumors; 92 operations involved multidisciplinary teams, including 54% of metastatic tumor operations and 74% of primary tumor operations. Patients receiving multidisciplinary management had higher body mass indexes (29.8 vs. 26.3 kg/m2; P = 0.008), larger tumors (258 vs. 55 cm³; P < 0.001), and higher American Society of Anesthesiologists scores (3 vs. 2; P = 0.049). Only larger tumor volume (odds ratio [OR], 1.007 per cm³; P < 0.001) and undergoing treatment for a malignant primary versus a metastatic tumor (OR, 23.4; P < 0.001) or benign primary tumor (OR, 29.3; P < 0.001) were predictive of multidisciplinary management. Although operations involving multidisciplinary teams were longer (467 vs. 231 minutes; P < 0.001) and had higher blood loss (1698 vs. 774 mL; P = 0.004), 30-day complication rates were similar (37 vs. 27%; P = 0.39). On multivariable analysis, only larger tumor volume (OR, 1.004 per cm³; P = 0.005) and longer surgical duration (OR, 1.002 per minute; P = 0.03) independently predicted higher 30-day complications. Conclusions: Although patients managed with multidisciplinary teams had larger tumors and worse baseline health, 30-day complications were similar. This finding suggests that the use of multidisciplinary teams may help to mitigate surgical morbidity in those with high baseline risk.

Original languageEnglish (US)
Pages (from-to)e558-e566
JournalWorld neurosurgery
Volume152
DOIs
StatePublished - Aug 2021

Keywords

  • Benign
  • Complication
  • Malignant
  • Metastasis
  • Multidisciplinary
  • Sacral
  • Tumor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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