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- Title
Mortality and complications following stabilization of femoral metastatic lesions: a population-based study of regional variation and outcome.
- Authors
Ristevski, Bill; Jenkinson, Richard J.; Stephen, David J. G.; Finkelstein, Joel; Schemitsch, Emil H.; McKee, Michael D.; Kreder, Hans J.
- Abstract
BACKGROUND: It is considered that patients at risk for spontaneous fracture due to metastatic lesions should undergo surgical stabilization before fracture occurs; however, prophylactic stabilization is associated with surgical morbidity and mortality. We sought to compare pathological fracture fixation versus prophylactic stabilization of diaphyseal femoral lesions for patients with femoral metastases and assess the rate of prophylactic surgery completed in all regions of Ontario. METHODS: Using population data sets, we identified all patients who had undergone femoral stabilization, either for pathological femoral fractures or for prophylactic fixation of femoral metastases before pathological fractures, between 1992 and 1997 in Ontario. We compared the rates of survival, serious medical and surgical complications and length of stay in hospital between the 2 groups. RESULTS: A total of 624 patients underwent surgical stabilization for femoral metastases. The most common sites of primary metastases were the lungs (26%), breasts (16%), kidneys (6%) and prostate (6%); 46% of patients had other or multiple primary metastases. Overall, 37% of lesions were fixed prophylactically, with wide variation by region (17.6%-72.2%). Patients who underwent prophylactic stabilization had better overall survival at all postoperative time points. This held true after adjusting for age, sex, comorbidities and type of cancer (p < 0.001). CONCLUSION: These data demonstrate a survival advantage with prophylactic fixation of metastatic femoral lesions combined with a relatively low perioperative risk excluding concomitant bilateral procedures. Ontario regional rates of prophylactic fixation vary enormously, with most patients not receiving prophylactic treatment.
- Subjects
ONTARIO; CANCER patients; METASTASIS; MORTALITY; PREOPERATIVE care; TREATMENT of fractures; SURGICAL complications
- Publication
Canadian Journal of Surgery, 2009, Vol 52, Issue 4, p302
- ISSN
0008-428X
- Publication type
journal article