Spine Journal - 2026-09-12 - Journal Article; Review
Impact of Surgical Planning Status on Survival, Complications, Resource Utilization, and Functional Outcomes of Metastatic Spine Tumor Surgery: Systematic Review.
Bangash AH, Boafo J, Lee M, Ghadimi K, Cao V, Alexandrov A, Belman L, Kirnaz S, Fluss R, Murthy SG, Gelfand Y, Yassari R, De la Garza Ramos R
Topics
Key Takeaway
Unplanned metastatic spine tumor surgery is associated with worse short-term survival (67% of studies) and higher complication rates (57% of studies), but long-term survival differences disappear beyond 3 months, while resource utilization remains persistently worse with 88% of studies reporting prolonged hospitalization.
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Summary
This systematic review examined whether surgical planning status (planned/elective vs. unplanned/urgent-emergent) affects survival, complications, resource utilization, and functional outcomes in metastatic spine tumor surgery across 28 studies and 76,291 patients. Unplanned surgery patients presented with markedly higher rates of non-ambulatory status (41% vs. 6%) and neurological compromise. Short-term survival and complication differences favored planned surgery, but these advantages were not sustained long-term, and patient-reported outcomes converged by 3 months; resource utilization, however, consistently favored planned surgery across 88% of reporting studies.
Key Limitation
The inability to perform meta-analysis due to inconsistent operational definitions of 'unplanned' surgery (4–48 hour cutoffs) across studies prevents quantification of effect size and limits the strength of conclusions about short-term outcome differences.
Original Abstract
BACKGROUND CONTEXT
Metastatic spine disease presents complex surgical decision-making challenges, where patients may undergo either planned or unplanned intervention depending on clinical presentation and system-level factors. Unplanned surgery appears to be associated with more advanced disease at presentation, including neurological compromise, yet its impact on short- and long-term outcomes remains incompletely understood.
PURPOSE
To synthesize the available evidence on the association between surgical planning status and outcomes in metastatic spine tumor surgery (MSTS)
STUDY DESIGN/SETTING
Systematic review
PATIENT SAMPLE
Patients managed with
MSTS OUTCOME MEASURES
We analyzed survival, perioperative complications, resource utilization metrics (length of stay, discharge disposition, healthcare costs), functional recovery, patient-reported outcomes, reoperation rates, and pain-related measures.
METHODS
A comprehensive search was conducted across PubMed/Medline, Cochrane Database of Systematic Reviews, and Epistemonikos from inception to May 14, 2025 for studies reporting outcomes by surgical planning status in MSTS. Surgical planning status was defined as planned (elective) versus unplanned (urgent/emergent) procedures. Study quality was assessed using the Methodological index for non-randomized studies (MINORS) tool. Short-term outcomes were defined as events occurring within 30 days postoperatively. The impact of surgical planning status on outcomes was systematically synthesized. Meta-analysis feasibility was assessed based on consistency in operational definitions.
RESULTS
Out of 1,279 articles, twenty-eight studies comprising 76,291 patients (mean age 62 years, 43% female) met inclusion criteria. The MINORS analysis yielded 79% of studies to be of "moderate" methodological quality. Meta-analysis was not undertaken due to substantial heterogeneity in surgical planning definitions, with timing cutoffs ranging from 4 to 48 hours. Patients undergoing unplanned surgery more frequently presented with non-ambulatory status (41% vs 6%) and neurological compromise, suggesting more advanced disease at presentation. Unplanned surgery was associated with worse short-term outcomes, including reduced survival (67% of reporting studies) and higher complication rates (57% of reporting studies). However, these differences diminished over time, with only 31% of reporting studies demonstrating long-term survival benefits for planned surgery. Patient-reported outcomes converged beyond three months postoperatively. In contrast, resource utilization consistently favored planned surgery, with prolonged hospitalization reported in 88% of reporting studies and increased costs associated with unplanned procedures.
CONCLUSION
Patients requiring unplanned MSTS have worse short-term outcomes but similar long-term outcomes compared to those undergoing planned surgery, may primarily reflect confounding by baseline disease severity and neurological compromise at presentation rather than detrimental effects of urgent intervention itself. The persistent impact of unplanned surgery lies in increased healthcare resource utilization associated with managing more advanced disease presentations. These findings support improving healthcare system strategies focused on early detection, coordinated referral pathways, and rapid-access spine oncology programs rather than delaying indicated surgery for patient optimization.