Adverse in-hospital outcomes after major cancer surgery in paraplegic patients

Study design: Observational cohort study. Objective: To test for the association between paraplegia and adverse in-hospital outcomes after major cancer surgery. Methods: Within National Inpatient Sample (2000–2019), we identified adult patients who underwent colectomy, radical hysterectomy, lung resection, gastrectomy and pancreatectomy for a primary cancer diagnosis. Descriptive analyses, propensity score matching (PSM, ratio 1:10) and multivariable logistic regression models (LRMs) were fitted. Setting: US. Results: We identified 957 (0.3%) paraplegics at colectomy, 250 (0.2%) at radical hysterectomy, 138 (0.3%) at lung resection, 94 (0.3%) at gastrectomy and 75 (0.2%) at pancreatectomy. After PSM and additional multivariable adjustment for patients, surgical and hospital characteristics, paraplegia independently predicted 12 of 12 examined endpoints after colectomy and radical hysterectomy, 11 of 12 after lung resection, 9 of 12 after pancreatectomy and 4 of 12 after gastrectomy. Across the examined surgeries, the magnitude of the increase in adverse in-hospital outcomes ranged from 2.4–3.7-fold for overall complications, 2.4–2.9-fold for intraoperative complications, 2.7–4.8-fold for vascular complications and 1.5–2.3-fold for length of stay ≥75^th-percentile. Paraplegics also exhibited a 3.8–6.3-fold higher rate of in-hospital mortality after colectomy, lung resection and pancreatectomy, but not after gastrectomy and radical hysterectomy. Conclusion: Across the five major oncologic procedures, paraplegic patients consistently exhibited higher rates of adverse in-hospital outcomes. The excess risk was most pronounced after colectomy, radical hysterectomy, and lung resection, moderate after pancreatectomy, and least evident after gastrectomy. Similarly, the magnitude of the disadvantage also varied depending on the definition of adverse in-hospital outcome and major cancer surgery type.