A predictive model of complications after spine surgery: the National Surgical Quality Improvement Program (NSQIP) 2005–2010

Bekelis, Kimon; Desai, Atman; Bakhoum, Samuel F.; Missios, Symeon

doi:10.1016/j.spinee.2013.08.009

Cited by 157 publications

(125 citation statements)

References 22 publications

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“…Anterior cervical spine surgery-associated complications in a retrospective case-control study an overstatement that anterior cervical approach constitutes one of the most rewarding spinal procedures (4)(5)(6)(7)(8)(9)(10)(11)(12).…”

Section: Review Articlementioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

120

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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Section: Review Articlementioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

120

113

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“…The accuracy of data collection by the NSQIP (including cumulative incidence and reasons for readmission) has been externally validated, 84 and this data source has been previously used to evaluate patients undergoing neurosurgical intervention, 4,8,12,14,15,28,29,45,54,83 including spine surgery. 2,6,9,10,25,40,53,59,61,82,91 Our institutional review board has exempted the de-identified NSQIP data set from individual review.…”

Section: Data Sourcementioning

confidence: 99%

“…3,7,9,49,59,60,61,71,77,90,91 Despite its utility in evaluating perioperative complications and adverse outcomes, few studies have used the NSQIP to analyze the outcomes of patients undergoing surgery for spinal tumors. The goal of this study was to evaluate the 30-day cumulative incidence, time to event, and predictors of major complications, unplanned reoperations, and readmissions after surgery for primary and secondary spinal tumors.…”

mentioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

100

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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“…(2) What is the value of the tool for patients with different risk levels? (3) Furthermore, does the tool have a diagnostic value for the prediction of complication?…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

“…Since bundled payment programs often include the reimbursement for complication and readmission, it has become increasingly important to identify patients at risk for perioperative complications [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Predicting medical complications in spine surgery: evaluation of a novel online risk calculator

et al. 2018

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Purpose The preoperative prediction of medical complications is essential to optimize perioperative management. SpineSage™ is a free of charge online calculator to predict medical complications in spine surgery. The current study utilizes it in patients undergoing spine surgery to assess whether the predicted risks would correlate with the actual complication rate in clinical practice. Methods A total of 273 consecutive patients who underwent spinal surgery were assessed. The risk of medical complications was predicted for each patient, and all medical complications were recorded within 30 days of surgery. Based on their predicted risk of complication, patients were divided into three risk groups (< 15, 15-30, > 30%). Results The predicted overall risk of medical complications was 14.7% and was comparable to the observed complication rate of 16.1%. The predicted risk for major medical complications (3.8%) was also similar to the observed complication rate (3.3%). Detailed analysis of the segmented risk groups suggests a close correlation between predicted and actual complication rates. Receiver operating characteristic analysis revealed an area under the curve of 0.71 (p < 0.001) for the prediction of overall medical complications and 0.85 (p < 0.001) for major complications. Conclusions The online risk calculator predicted both overall and major medical complications. The tool can assist in preoperative planning and counseling of patients.Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key pointsKeywords: Spine surgery, medical risk, medical complications, online calculator, risk assessment 1. Preoperative prediction of medical complications is essential to optimize perioperative management.2. SpineSage™ is a free of charge online calculator to predict medical complications in spine surgery.3. The current study analyzes whether the predicted risks would correlate with the actual complication rate in clinical practice. The median predicted risks and actually observed medical complication rate of all patients and risk groups are presented.

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A predictive model of complications after spine surgery: the National Surgical Quality Improvement Program (NSQIP) 2005–2010

Cited by 157 publications

References 22 publications

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Predicting medical complications in spine surgery: evaluation of a novel online risk calculator

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