Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Michael DiLuna

Second Advisor

Aladine A. Elsamadicy

Abstract

Background: Boney tumors of the spine pose a high morbidity among patients, requiring an extensive multidisciplinary treatment regimen, including surgical resection, chemotherapy, and radiation. Spinal metastases make up the majority of spinal boney tumors, while primary osseous tumors of the spine are much rarer. Due to the heterogeneity of tumor types, differences in presentation, and diversity of the patient population, treatment recommendations vary by individual, thus resulting in disparities in patient mortality and presenting a large burden on the healthcare system. Patient health status, including malnutrition, comorbidity burden, and frailty, as well as socioeconomic factors, such as race, have shown to influence these outcomes. Purpose: This dissertation aims to identify the impact of patient health and socioeconomic factors on clinical outcomes for patients with spinal boney tumors. Methods: We identified patients with spinal metastases and primary boney tumors of the spine, utilizing the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database and the Surveillance, Epidemiology, and End Results (SEER), respectively. We performed several cohort analyses to identify whether malnutrition, frailty, and race are associated with differences in patient demographics, adverse events, and mortality. To determine frailty, we utilized the risk analysis index (RAI) and modified frailty index (mFI-5). Results: Using the NSQIP database, we identified 1193 nourished and 420 malnourished patients with spinal metastases. Based on RAI, we found 479 robust, 1156 normal, 273 frail, and 65 very frail patients with spinal metastases, while based on mFI-5, we found 865 robust, 749 normal, 311 frail, and 49 very frail patients with spinal metastases. Differences in frailty based on RAI was associated with increased odds of 30-day mortality (Normal: p=0.001, Frail: p=0.007, Very Frail: p<0.001), while differences in frailty level based on the mFI-5 was not (Normal: p=0.920, Frail: 0.150, Very Frail: 0.163). Using the SEER database, we identified 1685 White, 139 Black, 388 Hispanic, and 203 Other (Asian, Pacific Islander, Native American, Other) patients who had primary osseous tumors of the spine. Overall, race was associated with differences in mortality, with White patients having the highest median (p<0.001) and 5-year (p<0.001) survival. Conclusions: RAI and race are both important clinical and socioeconomic factors that play a large role in patient mortality following boney tumors of the spine. It is essential that efforts be made to mitigate disparities due to patient-level factors.

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This is an Open Access Thesis.

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