17127 Background: There are approximately 250,000 people with spinal cord injury (SCI) in the US, and they have a high prevalence of smoking. A literature search yielded no published information concerning the clinical course of SCI patients who subsequently develop bronchogenic carcinoma and undergo pulmonary resection for this condition. We hypothesized that poorer outcomes of surgery would be observed in this population, as compared to neurally-intact patients. Methods: We conducted a study of all veterans at Department of Veterans Affairs (DVA) Medical Centers during fiscal years 1993–2002 who were diagnosed with SCI, subsequently developed non-small cell lung cancer and were then surgically treated with curative intent. Inclusion criteria included American Spinal Injury Association type A injury (complete loss of neural function distal to the injury site) and traumatic etiology. Data were compiled from national DVA datasets and supplemented by operative reports, pathology reports, progress notes, and discharge summaries. Results: Of 12,634 patients who underwent surgery for bronchogenic carcinoma, 55 also had codes for prior SCI; 7 were evaluable. The mean age was 64. Five (71%) had one or more co-morbid conditions in addition to their spinal cord injuries. All 7 underwent pulmonary lobectomy. Post-operative complications occurred in 4 patients (57%). Two patients died post-operatively on days 29 and 499, yielding a 30-day mortality rate of 14% and an in-hospital mortality rate of 29%. Conclusions: We believe this isthe only report in the English language literature on this topic. SCI patients with resectable bronchogenic carcinoma have a high incidence of co-morbid conditions. Those who undergo curative-intent surgery have high morbidity and mortality rates. This evidence suggests that SCI should be considered a risk factor for adverse outcomes of surgery for primary lung cancer, strengthening the case for alternative treatments. No significant financial relationships to disclose.
Surgery for constipation in patients with prior spinal cord injury: The Department of Veterans Affairs experience
