Surgical decision-making for spine metastatic disease

The general aim of this thesis is to understand what variables are important in surgical decision-making for patients with spine metastatic disease.
In chapter 1 we provide a general introduction.
In chapter 2 we assess factors associated with survival in 649 patients who underwent surgery for spine metastatic disease. Subsequently we develop three survival algorithms and test which one is most accurate. In chapter 3 we externally validate these algorithms, and conclude that our nomogram was best when compared with other commonly used survival algorithms.
In chapter 4 we assess risk factors for postoperative complications and reoperations. In addition, our study shows that complications may lead to premature death.
Subsequently, we conclude that perioperative allogeneic blood transfusions do not decrease survival (chapter 5) nor increase infection rates (chapter 6) after surgery for spine metastatic disease.
With a systematic review and meta-analysis in chapter 7, we conclude that surgery improves the patients’ quality of life (QoL) for one year, which might be attributable to improved physical, emotional, and functional well-being.
In chapter 8 we analyze patient reported outcome measures (PROM’s) from 100 patients, and recommend several questionnaires for measuring QoL, physical function, and pain intensity.
In chapter 9, based on PROM’s from 202 patients with bone metastatic disease, we conclude that impending pathologic fractures should be treated promptly to prevent deterioration in QOL, anxiety, and depression.
Final, we provide discussion points (chapter 10), recommendations (chapter 11), an English summary (chapter 12), and a Dutch summary (chapter 13).