AB162. SOH26AB_0338. Evaluating referral patterns in skeletal metastases: a single institution comparison of spinal and appendicular pathways

Background: Metastatic disease of the spine and appendicular skeleton represents a major source of pain, functional decline, and acute clinical deterioration in patients with advanced malignancy. Management often requires rapid imaging, multidisciplinary decision-making, and timely orthopaedic intervention. However, referral processes are highly variable, contributing to delays and inconsistent alignment with best-practice guidelines. This study aimed to characterise referral patterns and service demands across spinal and appendicular metastatic presentations to inform the development of a unified multidisciplinary referral pathway.

Methods: A retrospective review of all referrals relating to both spinal and appendicular skeletal metastasis, between 1^st of January 2025 and 1^st of November 2025 was conducted within a single tertiary orthopaedic centre (St. Vincent’s University Hospital). Data included demographics, referring specialty, primary tumour type, lesion site, presence of pathological fracture or neurological deficit, multidisciplinary meeting discussions, and operative intervention.

Results: Fifty-two referrals were identified: 26 spinal and 26 appendicular. Oncology services constituted the majority of referrals (54–62%), though overall referral sources were heterogeneous. Breast cancer was the most common primary malignancy. Pathological fractures occurred in nearly half of spinal referrals and 38% of appendicular referrals, with the latter predominantly affecting the femur and pelvis. Neurological deficit was present in one-third of spinal cases. Nine spinal referrals proceeded to formal multidisciplinary discussion, with three requiring surgical intervention. In the appendicular cohort, 40% underwent surgery, including fixation or endoprosthetic reconstruction. Seven patients with appendicular metastasis had concomitant spinal metastases.

Conclusions: Across both skeletal regions, metastatic disease referrals imposed a significant and complex service burden. The variability in referral patterns supports the need for a streamlined, multidisciplinary institutional pathway to improve timeliness, coordination, and quality of metastatic bone care.

Keywords: Bone neoplasm; spinal neoplasm; skeletal metastasis; orthopaedics; multidisciplinary team