Trends and postoperative complications of spinal metastasis surgery in Thailand between 2015 and 2024: a nationwide retrospective cohort study

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Abstract Study design Nationwide retrospective cohort study. Objective To evaluate 10-year national trends, postoperative complications of spinal metastasis surgery in Thailand. Methods Individual-level data were obtained from five national healthcare databases covering the Thai population, with spinal metastasis patients identified using ICD-10 TM (C79.5, C79.8) and ICD-9 CM codes (03.0, 03.09, 03.4, 81.00–81.08). The index surgical utilization rate was calculated by selecting only first-time surgeries, whereas the annual surgical episode rate encompassed all surgical cases, including re-operations. Secondary outcomes comprised patient demographics, complications, and inflation-adjusted healthcare expenditures. Results Among the 16,244 patients (mean age: 57 years; 53.5% female), lung (25.01%) and breast (21.75%) cancers were the common primary malignancies. The overall annual index surgical utilization rate was 2.40 and the annual surgical episode rate was 2.47 per 100,000 population. Meanwhile, the mean Charlson Comorbidity Index (CCI) rose annually from 2.46 in 2015 to 4.66 in 2024. Surgical volume was heavily centralized in Bangkok (77.3%). The overall postoperative complication rate was 12.8%, consisting of 8.7% medical and 2.9% surgical complications, with a 2.8% reoperation rate. The median length of stay (LOS) was 11 days despite annual fluctuations. The average in-hospital mortality rate demonstrated a corresponding upward trend alongside rising comorbidity burdens, averaging 4.2% overall. For the surgical cohort, the median in-hospital survival time was 3.65 months, the average adjusted cost per admission was 5,033.16 USD. Conclusion The volume of spinal metastasis surgeries in Thailand has risen over the past decade. This growth is accompanied by modestly higher in-hospital mortality, while postoperative length of stay fluctuated annually. These trends directly reflect a rapidly shifting demographic toward an aging surgical patient cohort and aggressive primary malignancies.