Background: Spinal metastases (SM) are increasingly common. In an aging population, this trend raises concerns regarding the safety and efficacy of surgical treatment (ST) in geriatric patients. This study aimed to compare postoperative outcomes, complications, recurrence, readmission, and mortality between geriatric and non-geriatric patients undergoing ST for SM. Methods: Our retrospective cohort study included 277 patients who underwent ST for SM between 2012 and 2024. Patients were stratified into non-geriatric (< 70 years, n = 161) and geriatric (≥ 70 years, n = 116) groups. Clinical and surgical parameters, including complications, recurrence, readmission, and survival, were analyzed. Results: Geriatric patients had a higher preoperative comorbidity burden and lower functional status. However, early outcomes, such as postoperative complications, readmission rates, and local tumor recurrence, did not differ significantly between age groups. Median overall survival was 12.0 months in patients < 70 years and 10.5 months in patients ≥ 70 years ( p = 0.026). The multivariable analysis shows that obesity ( p = 0.028), Surgical stabilization ( p = 0.043), prolonged postoperative mechanical ventilation ( p = 0.041), early surgical complications ( p = 0.009), and a preoperative Karnofsky Performance Scale < 70% ( p = 0.036) were independently associated with increased 1-year mortality in geriatric patients. Conclusion: Our data demonstrates that geriatric patients undergoing ST for SM did not experience worse early postoperative outcomes. Careful patient selection based on functional status and perioperative risk factors remains essential.

Introduction: The routine insertion of a postoperative intracranial drain following surgical evacuation of brain abscesses or subdural empyemas is practiced by some surgeons to facilitate pus evacuation and to enable cavity lavage, but robust evidence for clinical benefit is lacking. This study evaluates whether postoperative drain placement affects reoperation rates, length of hospital stay, and duration of antibiotic therapy. Methods: We performed a retrospective review of consecutive adult patients who underwent surgical drainage or excision of a primary intracranial abscess or empyema at our tertiary center between January 2020 and January 2026. Patients were grouped by whether a postoperative intracranial drain was placed. The primary endpoint was recurrence requiring reoperation. Secondary endpoints included hospital length of stay, total duration of antibiotic therapy, and operative time. Continuous variables were compared with t-tests and categorical variables with Fisher’s exact test; p < 0.05 was considered statistically significant. Results: Eighty procedures were identified, and 36 patients met inclusion criteria for final analysis; eight (22.2%) received a postoperative intracranial drain, and 28 (77.8%) did not. Overall, 13 patients (36.1%) required reoperation for radiological or clinical progression. Reoperation occurred in 50% of patients with a drain and 32.1% without a drain (p = 0.422). Median hospital stay and duration of antibiotic therapy did not differ significantly between groups (median hospital stay 27.1 vs. 23.0 days, p = 0.50; median antibiotic duration 67.3 vs. 51.7 days, p = 0.445). Operative time and infection volume rates were also similar between cohorts. Conclusions: In this single-center retrospective cohort, placement of a postoperative intracranial drain after surgical management of brain abscesses or empyemas was not associated with reduced reoperation rates, shorter hospitalization, or shorter antibiotic treatment. Given the absence of demonstrable clinical benefit and the potential risks related to drain placement, routine insertion of postoperative drains cannot be recommended.

Background: The prognostic assessment of patients with spinal metastases is primarily based on clinical and radiological parameters. Biological tumor characteristics such as the proliferation marker Ki-67 have prognostic relevance in various metastatic settings. This study aimed to evaluate the prognostic impact of the Ki-67 proliferation index on survival outcomes in patients undergoing surgery for spinal metastases. Methods: We included 166 patients who underwent surgical treatment for spinal metastases at our university clinic between 2015 and 2024. Clinical, functional, tumor-related, and perioperative variables were collected. Receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory ability of Ki-67, and comparisons were made between patient groups according to Ki-67 expression (≤20% vs. >20%). Results: Based on ROC analysis, Ki-67 demonstrated a moderate but significant predictive ability for 1-year mortality (area under the curve [AUC]: 0.69, p = 0.001). Patients with a Ki-67 index of >20% showed a significantly shorter overall survival than those with a lower Ki-67 index of ≤20% (median overall survival: 5.0 vs. 14.5 months, p < 0.001). One-year mortality was significantly higher in the high Ki-67 group (78.9% vs. 41.8%, p = 0.001). High Ki-67 expression was associated with more aggressive tumor characteristics but was not associated with increased perioperative morbidity. Conclusions: The Ki-67 proliferation index is a significant prognostic biomarker in surgically treated patients with spinal metastases. A Ki-67 index threshold of 20% identifies patients at increased risk of early mortality and significantly reduced overall survival.