Postoperative complications in adult spinal deformity patients with a mental illness undergoing reconstructive thoracic or thoracolumbar spine surgery

Shah, Ishan; Wang, Christopher; Jain, Nick S.; Formanek, Blake; Buser, Zorica; Wang, Jeffrey C.

doi:10.1016/j.spinee.2018.10.003

Cited by 16 publications

(6 citation statements)

References 35 publications

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“…Accumulating evidence suggests that stress, anxiety, and depression directly influence the immune response and, consequently, woundhealing as well [30][31][32] . This was further supported by a retrospective study of adult patients with spinal deformity, which showed that patients with depression and/or anxiety (n = 327) had an increased risk of postoperative infections (odds ratio = 1.743, p = 0.022) compared with the matched control group 33 . In our study, patients who scored worse on the SF-12 MCS score before surgery were more likely to develop SSI; however, development of SSI had no impact on mental functioning as assessed with the SF-12 MCS score in the postoperative period.…”

Section: Discussionmentioning

confidence: 79%

The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders

Urquhart

Gurr

Siddiqi

et al. 2021

Journal of Bone and Joint Surgery

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Background:Few reports in the literature have described the long-term outcome of postoperative infection from the patient perspective. The aim of the present study was to determine if complicated surgical site infection (SSI) affects functional recovery and surgical outcomes up to 2 years after posterior instrumented thoracolumbar surgery for the treatment of degenerative disorders.Methods:This retrospective cohort study involved patients who had been enrolled in a previous randomized controlled trial that examined antibiotic use for open posterior multilevel thoracolumbar or lumbar instrumented fusion procedures. In the present study, patients who had SSI (n = 79) were compared with those who did not (n = 456). Patient-reported outcome measures (PROMs) included the Oswestry Disability Index (ODI), leg and back pain scores on a numeric rating scale, Short Form-12 (SF-12) summary scores, and satisfaction with treatment at 1.5, 3, 6, 12, and 24 months. Surgical outcomes included adverse events, readmissions, and additional surgery.Results:The median time to infection was 15 days. Of the 535 patients, 31 (5.8%) had complicated infections and 48 (9.0%) had superficial infections. Patients with an infection had a higher body mass index (BMI) (p = 0.001), had more commonly received preoperative vancomycin (p = 0.050), were more likely to have had a revision as the index procedure (p = 0.004), had worse preoperative mental functioning (mental component summary score, 40.7 ± 1.6 versus 44.1 ± 0.6), had more operatively treated levels (p = 0.024), and had a higher rate of additional surgery (p = 0.001). At 6 months after surgery, patients who developed an infection scored worse on the ODI by 5.3 points (95% confidence interval [CI], 0.4 to 10.1 points) and had worse physical functioning by −4.0 points (95% CI, −6.8 to −1.2 points). Comparison between the groups at 1 and 2 years showed no difference in functional outcomes, satisfaction with treatment, or the likelihood of achieving the minimum clinically important difference (MCID) for the ODI.Conclusions:SSI more than doubled the post-discharge emergency room visit and additional surgery rates. Patients with SSI initially (6 months) had poorer overall physical function representing the delay to recovery; however, the negative impact resolved by the first postoperative year.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 79%

The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders

Urquhart

Gurr

Siddiqi

et al. 2021

Journal of Bone and Joint Surgery

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“…the Koenig Depression Scale (KDS)] and a preoperative diagnosis of depression have failed to find association with perioperative complications following multi-level fusions [30][31][32]. Therefore, our findings of significant association between depression/anxiety and eLOS are among the first reported for deformity patients [33]. Additionally, given that a subset of patients who have eLOS may inherently require post-acute care, it follows that the variable was significant for predicting rehabilitation discharge [34].…”

Section: Discussionmentioning

confidence: 90%

Risk factors for extended length of stay and non-home discharge in adults treated with multi-level fusion for lumbar degenerative pathology and deformity

et al. 2022

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Purpose To identify independent risk factors, including the Risk Assessment and Prediction Tool (RAPT) score, associated with extended length of stay (eLOS) and non-home discharge following elective multi-level instrumented spine fusion operations for diagnosis of adult spinal deformity (ASD) and lumbar degenerative pathology. Methods Adults who underwent multi-level ($$\ge 3$$ ≥ 3 segments) instrumented spine fusions for ASD and lumbar degenerative pathology at a single institution (2016–2021) were reviewed. Presence of a pre-operative RAPT score was used as an inclusion criterion. Excluded were patients who underwent non-elective operations, revisions, operations for trauma, malignancy, and/or infections. Outcomes were eLOS (> 7 days) and discharge location (home vs. non-home). Predictor variables included demographics, comorbidities, operative information, Surgical Invasiveness Index (SII), and RAPT score. Fisher’s exact test was used for univariate analysis, and significant variables were implemented in multivariate binary logistic regression, with generation of 95% percent confidence intervals (CI), odds ratios (OR), and p-values. Results Included for analysis were 355 patients. Post-operatively, 36.6% (n = 130) had eLOS and 53.2% (n = 189) had a non-home discharge. Risk factors significant for a non-home discharge were older age (> 70 years), SII > 36, pre-op RAPT < 10, DMII, diagnosis of depression or anxiety, and eLOS. Risk factors significant for an eLOS were SII > 20, RAPT < 6, and an ASA score of 3. Conclusion The RAPT score and SII were most important significant predictors of eLOS and non-home discharges following multi-level instrumented fusions for lumbar spinal pathology and deformity. Preoperative optimization of the RAPT’s individual components may provide a useful strategy for decreasing LOS and modifying discharge disposition.

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“…The strongest evidence for this was provided by Shah et al . who noted that depression and anxiety were associated with increased rates of perioperative infection and respiratory complications following surgical correction of ASD after matching patients for sex, age, and Charlson Comorbidity Index (CCI) [ 71 ]. While Soroceanu et al .…”

Section: Resultsmentioning

confidence: 99%

Preoperative medical assessment for adult spinal deformity surgery: a state-of-the-art review

et al. 2023

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Introduction The purpose of this study is to provide a state-of-the-art review regarding risk factors for perioperative complications in adult spinal deformity (ASD) surgery. The review includes levels of evidence for risk factors associated with complications in ASD surgery. Methods Using the PubMed database, we searched for complications, risk factors, and adult spinal deformity. The included publications were assessed for level of evidence as described in clinical practice guidelines published by the North American Spine Society, with summary statements generated for each risk factor (Bono et al. in Spine J 9:1046–1051, 2009). Results Frailty had good evidence (Grade A) as a risk for complications in ASD patients. Fair evidence (Grade B) was assigned for bone quality, smoking, hyperglycemia and diabetes, nutritional status, immunosuppression/steroid use, cardiovascular disease, pulmonary disease, and renal disease. Indeterminate evidence (Grade I) was assigned for pre-operative cognitive function, mental health, social support, and opioid utilization. Conclusions Identification of risk factors for perioperative complications in ASD surgery is a priority for empowering informed choices for patients and surgeons and managing patient expectations. Risk factors with grade A and B evidence should be identified prior to elective surgery and modified to reduce the risk of perioperative complications.

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Postoperative complications in adult spinal deformity patients with a mental illness undergoing reconstructive thoracic or thoracolumbar spine surgery

Cited by 16 publications

References 35 publications

The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders

The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders

Risk factors for extended length of stay and non-home discharge in adults treated with multi-level fusion for lumbar degenerative pathology and deformity

Preoperative medical assessment for adult spinal deformity surgery: a state-of-the-art review

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