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Preliminary study of anesthetic risk factors in surgery for pathologic fractures secondary to metastatic tumors
Anesth Pain Med 2018;13(2):222-31
Published online April 30, 2018
© 2018 The Korean Society of Anesthesiologists.

Tae Kwane Kim, Jun Rho Yoon , Youngmyung Noh, Hye Jin Yoon, Mi Sun Park, and Young-hye Kim
Department of Anesthesiology and Pain Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Jun Rho Yoon, M.D., Ph.D.
Department of Anesthesiology and Pain Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea
Tel: 82-32-340-7075
Fax: 82-32-340-2255
Received July 3, 2017; Revised October 2, 2017; Accepted October 13, 2017.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Despite advances in the treatment of primary cancer, metastatic pathologic fractures still affect the survival of cancer patients. The goals of surgery, such as those with terminal cancer, are to maintain a maximum level of independence and improve the quality of life. A patient may be a poor surgical candidate because of a short life expectancy or illness that is too severe to benefit from surgical fixation. Moreover, this surgery is an operation accompanied with significant morbidity and mortality. This retrospective study investigated the characteristics of these patients and assessed the influence of anesthetic risk factors on the outcome.
Methods: The records of 45 patients with pathologic fractures who underwent surgical stabilization for metastatic factors from 1 January 1995 to 31 December 2013 at our hospital were reviewed. Demographic data, various severity scores, anesthetic factors, and survival were reviewed.
Results: The most common sites of primary tumors were lung, liver and stomach. The predominant sites of pathologic fractures were the femur (71.1%); six lesions were in the humerus and four in the spine. Univariate and multivariate analyses identified several prognostic factors with a significantly worse influence on survival, including lung tumor and Acute Physiology and Chronic Health Evaluation (APACHE) II score.
Conclusions: Although the number of patients was too small to result in a satisfactory appraisal, the most important step is to select candidates to gain the benefits of palliative surgery. We suggest the possibility of APACHE II scoring and the recognition of lung cancer in making the clinical decision of performing the palliative osteosyntheses for patients with pathologic fractures.
Key Words : Anesthesia, Cancer, Pathologic fracture, Survival.

April 2018, 13 (2)
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