Annals of Surgical Oncology

, Volume 23, Issue 3, pp 801–810 | Cite as

Complications and Postoperative Mortality Rate After Surgery for Pathological Femur Fracture Related to Bone Metastasis: Analysis of a Nationwide Database

  • Yusuke Tsuda
  • Hideo Yasunaga
  • Hiromasa Horiguchi
  • Kiyohide Fushimi
  • Hirotaka Kawano
  • Sakae Tanaka
Bone and Soft Tissue Sarcomas



Currently, there are few reports regarding predictors of postoperative complications and short-term mortality after surgery for pathological femur fracture related to bone metastasis.


Using data from the Japanese Diagnosis Procedure Combination Database from 2007 to 2012, we retrospectively identified 1497 patients who underwent internal fixation (n = 1073) or proximal femur resection and endoprosthetic reconstruction of the proximal femur (n = 424) for pathological femur fracture related to bone metastasis. Multivariable logistic regression analysis was performed to examine the relationship of various factors with postoperative complications and 30-day mortality.


The overall 30-day mortality after surgery was 2.6 %, and the proportion of postoperative complications was 12.1 %. Multivariable logistic regression analysis showed that postoperative complications overall were significantly associated with older age [odds ratio (OR), 2.15; 95 % confidence interval (CI) 1.23–3.74 for age ≥80 vs. ≤59 years]; lung carcinoma (OR 2.05; 95 % CI 1.47–2.86); esophageal carcinoma (OR 4.41; 95 % CI 1.57–12.43); higher Charlson Comorbidity Index (OR 1.50; 95 % CI 1.03–2.18 for ≥9 vs. 8); and blood transfusion (OR 1.57; 95 % CI 1.14–2.15). Thirty-day mortality also was significantly higher in patients with rapid-growth tumors, visceral metastasis, internal fixation, and no postoperative chemotherapy in the univariate analysis.


Older age, type of primary tumor, higher Charlson Comorbidity Index, and blood transfusion were associated with higher morbidity. These findings can provide important information to assess perioperative risk in patients with pathological femur fracture related to bone metastasis.


Postoperative Complication Bone Metastasis Internal Fixation Esophageal Carcinoma Charlson Comorbidity Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Yusuke Tsuda
    • 1
  • Hideo Yasunaga
    • 2
  • Hiromasa Horiguchi
    • 3
  • Kiyohide Fushimi
    • 4
  • Hirotaka Kawano
    • 1
  • Sakae Tanaka
    • 1
  1. 1.Department of Orthopedic Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
  3. 3.Department of Clinical Data Management and Research, Clinical Research CenterNational Hospital Organization HeadquartersTokyoJapan
  4. 4.Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of MedicineTokyoJapan

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