Increased Risk of Complications After Anterior Cervical Discectomy and Fusion in the Elderly

Buerba, Rafael A.; Giles, Erica; Webb, Matthew L.; Fu, Michael C.; Gvozdyev, Borys V.; Grauer, Jonathan N.

doi:10.1097/brs.0000000000000606

Cited by 77 publications

(41 citation statements)

References 34 publications

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“…The overall incidence of wound complications was lower than the reported 3.5% observed in a similarly structured NSQIP study on pediatric patients. 16 Since increasing age has been previously reported as a predictor for postoperative complications, 38 a higher rate of wound infection was expected. However, it is important to consider that the incidence varied from 2.0% to 4.1% within the NSQIP database for adults, and the pediatric article reported data from a single year.…”

Section: Discussionmentioning

confidence: 98%

Incidence, Impact, and Risk Factors for 30-Day Wound Complications Following Elective Adult Spinal Deformity Surgery

Lee

Shin

Kothari

et al. 2017

Global Spine Journal

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Study Design:Case-control study.Objective:To determine the incidence, impact, and risk factors for wound complications within 30 days following elective adult spinal deformity surgery.Methods:Current Procedural Terminology and International Classification of Diseases, Ninth Edition, diagnosis codes were used to query the database for adults who underwent spinal deformity surgery from 2010 to 2014. Patients were separated into groups of those with and without wound complications. Univariate analysis and multivariate logistic regression were used to analyze the influence of patient factors, operative variables, and clinical characteristics on the incidence of postoperative wound complication. This study was qualified as exempt by the Mount Sinai Hospital Institutional Review Board.Results:A total of 5803 patients met the criteria for this study. Wound complications occurred in 140 patients (2.4%) and were significantly associated with other adverse outcomes, including higher rates of unplanned reoperation (P < .0001) and prolonged length of stay (P < .0001). Regardless of fusion length, wound complication rates were higher with a posterior approach (short = 2.7%; long = 3.7%) than an anterior one (short = 2.2%; long = 2.7). According to the multivariate analysis, posterior fusion (odds ratio [OR] = 1.8; P = .010), obese class II (OR = 1.7; P = .046), obese class III (OR = 2.8; P < .0001), preoperative blood transfusion (OR = 6.1; P = .021), American Society of Anesthesiologists class ≥3 (OR = 1.7; P = .009), and operative time >4 hours (OR = 1.8; P = .006) were statistically significant risk factors for wound complications.Conclusion:The 30-day incidence of wound complication in adult spinal deformity surgery is 2.4%. The risk factors for wound complication are multifactorial. This data should provide a step toward developing quality improvement measures aimed at reducing complications in high-risk adults.

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Section: Discussionmentioning

confidence: 98%

Incidence, Impact, and Risk Factors for 30-Day Wound Complications Following Elective Adult Spinal Deformity Surgery

Lee

Shin

Kothari

et al. 2017

Global Spine Journal

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“… 20 - 22 Carreon et al 5 found in an analysis of elderly patients undergoing lumbar decompression and arthrodesis that patients ≥75 years of age had a 1.6-day longer LOS compared with patients aged 65 to 69 years (9.3 vs 10.9 days). 5 Additionally, in a retrospective analysis of 6,253 patients undergoing ACDF, Buerba et al 23 identified patients 65 to 74 years old experienced a 1.59 greater odds of LOS ≥3 days and patients >75 years old experienced a 2.50 greater odds of LOS ≥3 days. Patients ≥61 years of age were more than 3 times as likely to experience pulmonary complications.…”

Section: Discussionmentioning

confidence: 99%

Elderly Age as a Risk Factor for 30-Day Postoperative Outcomes Following Elective Anterior Cervical Discectomy and Fusion

Capua

Somani

Kim

et al. 2017

Global Spine Journal

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Study Design:Retrospective analysis of prospectively collected data.Objective:Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spinal procedures. Considering the high success and low complications rate of ACDF and high prevalence of age-related degeneration of the cervical spine, the rates of ACDF are expected to continually rise. The objective is to identify the association between patient age and 30-day postoperative outcomes following elective ACDF.Methods:The 2010-2014 ACS-NSQIP database was queried using Current Procedural Terminology (CPT) codes 22551 or 22554. Patients were divided into age quartiles (18-45, 46-52, 53-60, and ≥61 years). Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications in the elderly patient population.Results:A total of 20 563 patients met the inclusion criteria for the study. The analyses found quartile 4 had an increased odds of length of stay (LOS) ≥5 days (odds ratio [OR] = 2.05, confidence interval [CI ] = 1.62-2.60), pulmonary complications (OR = 3.25, CI = 1.81-5.84), urinary tract infections (UTI) (OR = 2.25, 1.04-4.87, P = .038), cardiac complication (OR = 6.01, CI = 1.36-26.62, P = .018), and sepsis (OR = 4.38, CI = 1.30-14.70, P = .017). Quartiles 2 and 4 had an increased odds of venous thromboembolism (OR = 3.13, CI = 1.14-8.56, P = .026; OR = 3.83, CI = 1.44-10.20, P = .007). Quartiles 3 and 4 experienced an increased odds of unplanned readmission (OR = 1.44, CI = 1.01-2.05, P = .045; OR = 1.88, CI = 1.33-2.66). All P values are <.001 unless otherwise noted.Conclusion:Elderly patients experienced an increased odds of LOS ≥5 days, pulmonary complications, cardiac compilations, venous thromboembolism, UTI, sepsis, and unplanned readmission. Identification of these factors can improve the selection of appropriate surgical candidates and postoperative safety.

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“…Age was stratified into three groups-18 to 64, 65 to 74, !75-as 65 is a standard cutoff in the literature 62,63 and 75 is one SD above the mean for our dataset. 64 Clinical descriptors included preoperative functional status, presence of system-specific and general comorbidities, and ASA score. Comorbidities were coded by system for cardiac (angina, congestive heart failure, myocardial infarction, previous percutaneous coronary intervention or cardiac surgery, peripheral vascular disease, stroke, or transient ischemia attack) and respiratory (chronic obstructive pulmonary disease, dyspnea, pneumonia) disorders.…”

Section: Assessments and Outcome Measuresmentioning

confidence: 99%

Obesity Is an Independent Risk Factor of Early Complications After Revision Spine Surgery

Sing

Yue

Metz

et al. 2016

SPINE

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Increased Risk of Complications After Anterior Cervical Discectomy and Fusion in the Elderly

Abstract: 3.

Cited by 77 publications

References 34 publications

Incidence, Impact, and Risk Factors for 30-Day Wound Complications Following Elective Adult Spinal Deformity Surgery

Incidence, Impact, and Risk Factors for 30-Day Wound Complications Following Elective Adult Spinal Deformity Surgery

Elderly Age as a Risk Factor for 30-Day Postoperative Outcomes Following Elective Anterior Cervical Discectomy and Fusion

Obesity Is an Independent Risk Factor of Early Complications After Revision Spine Surgery

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