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Background: Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency that requires prompt intervention to prevent poor outcomes. Data is lacking on contemporary trends in the incidence and mortality outcomes of MESCC. This study aimed to examine the trends in the incidence and outcomes of MESCC hospitalizations. Methods: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database (2009–2019) was queried to identify all malignant cancer patients admitted for spinal cord compression using ICD-9 and ICD-10 codes. We obtained the annual MESCC incidence rates per 1 million hospitalizations. Trends were assessed using the annual percentage change (APC) by joinpoint regression. The primary outcomes were inpatient mortality, length of stay (LOS), and total hospital charges (THC). Results: There was a total of 39,666 hospitalizations with a diagnosis of MESCC. The average yearly mortality rate was 1.6%. Over the timeframe, the incidence of MESCC …