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Risk factors for perioperative morbidity in spine surgeries of different complexities: a multivariate analysis of 1009 consecutive patients


Farshad, M; Bauer, D E; Wechsler, C; Gerber, C; Aichmair, A (2018). Risk factors for perioperative morbidity in spine surgeries of different complexities: a multivariate analysis of 1009 consecutive patients. The Spine Journal:1529-9430.

Abstract

BACKGROUND CONTEXT There is a broad spectrum of complications during or after surgical procedures, with differing incidences reported in the published literature. Heterogeneity can be explained by the lack of an established evidence-based classification system for documentation and classification of complications in a standardized manner. PURPOSE To identify predictive risk factors for peri- and early post-operative morbidities in spine surgeries of different complexities in a large cohort of consecutive patients. STUDY DESIGN Retrospective case series. OUTCOME MEASURES Occurrence of peri- and early post-operative morbidities. METHODS A classification of surgical complexity (grade I-III) was created and applied to 1009 patients who consecutively underwent spine surgery at a single university hospital. The incidence and type of peri- and early post-operative morbidities were documented. Multivariate binary logistic regression analyzed risk factors for (a) hospital stay≥10 days, (b) intermediate care unit (IMC) stay≥24 hours, (c) blood loss>500mL, and occurrence of a (d) surgical or (e) medical morbidity. RESULTS A deviation from the regular postoperative course (defined as "morbidity") included surgical reasons such as relapse of symptoms of any kind (3.3%), wound healing problems (2.4%), implant-associated complications (1.6%), post-operative neurological deficits (1.5%), infection (1.5%), fracture (0.8%), and dural tear in need of revision (0.6%). Medical reasons included anemia (1.8%), symptomatic electrolyte derailment (1.0%), and cardiac complications (0.7%), among others. An independent risk factor associated with a surgical reason for an irregular post-operative course was male gender. For a medical reason high creatinine levels preoperatively, higher blood loss, and systemic steroid use were identified as risk factors. Independent risk factors for a prolonged hospitalization were preoperatively high CRP, prolonged postoperative IMC stay, and revision surgery. Spinal stabilization/fusion surgery, particularly if involving the lumbosacral spine, age, and length of surgery were associated with a blood loss>500mL. Higher surgical complexity, involvement of the pelvis in instrumentation, ASA class≥3, and higher creatinine levels preoperatively were associated with a postoperative IMC stay>24 hours. CONCLUSION The present study confirms several modifiable and non-modifiable risk factors for peri- and early post-operative morbidities in spine surgery, among which surgical factors (complexity, revision surgery, instrumentation (including the pelvis etc.)) play a crucial role. A classification of surgical complexity is proposed and validated.

Abstract

BACKGROUND CONTEXT There is a broad spectrum of complications during or after surgical procedures, with differing incidences reported in the published literature. Heterogeneity can be explained by the lack of an established evidence-based classification system for documentation and classification of complications in a standardized manner. PURPOSE To identify predictive risk factors for peri- and early post-operative morbidities in spine surgeries of different complexities in a large cohort of consecutive patients. STUDY DESIGN Retrospective case series. OUTCOME MEASURES Occurrence of peri- and early post-operative morbidities. METHODS A classification of surgical complexity (grade I-III) was created and applied to 1009 patients who consecutively underwent spine surgery at a single university hospital. The incidence and type of peri- and early post-operative morbidities were documented. Multivariate binary logistic regression analyzed risk factors for (a) hospital stay≥10 days, (b) intermediate care unit (IMC) stay≥24 hours, (c) blood loss>500mL, and occurrence of a (d) surgical or (e) medical morbidity. RESULTS A deviation from the regular postoperative course (defined as "morbidity") included surgical reasons such as relapse of symptoms of any kind (3.3%), wound healing problems (2.4%), implant-associated complications (1.6%), post-operative neurological deficits (1.5%), infection (1.5%), fracture (0.8%), and dural tear in need of revision (0.6%). Medical reasons included anemia (1.8%), symptomatic electrolyte derailment (1.0%), and cardiac complications (0.7%), among others. An independent risk factor associated with a surgical reason for an irregular post-operative course was male gender. For a medical reason high creatinine levels preoperatively, higher blood loss, and systemic steroid use were identified as risk factors. Independent risk factors for a prolonged hospitalization were preoperatively high CRP, prolonged postoperative IMC stay, and revision surgery. Spinal stabilization/fusion surgery, particularly if involving the lumbosacral spine, age, and length of surgery were associated with a blood loss>500mL. Higher surgical complexity, involvement of the pelvis in instrumentation, ASA class≥3, and higher creatinine levels preoperatively were associated with a postoperative IMC stay>24 hours. CONCLUSION The present study confirms several modifiable and non-modifiable risk factors for peri- and early post-operative morbidities in spine surgery, among which surgical factors (complexity, revision surgery, instrumentation (including the pelvis etc.)) play a crucial role. A classification of surgical complexity is proposed and validated.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:13 February 2018
Deposited On:22 Feb 2018 11:58
Last Modified:14 Mar 2018 15:38
Publisher:Elsevier
ISSN:1529-9430
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.spinee.2018.02.003
PubMed ID:29452285

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