Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients

Abstract

Purpose Major peri-operative complications for adult spinal deformity (ASD) surgery remain common. However, risk factors have not been clearly defined. Our objective was to identify patient and surgical parameters that correlate with the development of major peri-operative complications with ASD surgery. Methods This is a multi-center, retrospective, consecutive, case-control series of surgically treated ASD patients.All patients undergoing surgical treatment for ASD at eight centers were retrospectively reviewed. Each center identified 10 patients with major peri-operative complications. Randomization tables were used to select a comparably sized control group of patients operated during the same time period that they did not suffer major complications. The two groups were analyzed for differences in clinical and surgical factors. Analysis was restricted to noninstrumentation related complications. -012-2370-4 significant differences between the complications and control groups based on the demographics, ASA grade, comorbidities, body mass index, prior surgeries, pre-operative anemia, smoking, operative time or ICU stay (p [ 0.05). Hospital stay was significantly longer for the complications group (14.4 vs. 7.9 days, p = 0.001). The complications group had higher percentages of staged procedures (46 vs. 37 %, p = 0.011) and combined anterior-posterior approaches (56 vs. 32 %, p = 0.011) compared with the control group. Conclusion The major peri-operative complication rate was 8.4 % for 953 surgically treated ASD patients. Significantly higher rates of complications were associated with staged and combined anterior-posterior surgeries. None of the patient factors assessed were significantly associated with the occurrence of major peri-operative complications. Improved understanding of risk profiles and procedure-related parameters may be useful for patient counseling and efforts to reduce complication rates.123 Eur Spine J (2012) 21:2603-2610 DOI 10.1007/s00586

Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience

“…Some authors have reported on specific complications like surgical site infection rate in adult deformity approaching 5.5 % with deep infection being 3.5 % [16]. Schwab et al [17] reported major perioperative complication rate in the order of 8.4 %. Cho et al [18] reported major complications in 34.3 % of the patients undergoing revision deformity surgery.…”

Importance of balance and profile in adult spinal reconstruction

“…These are all performed by a posterior approach and rely on solid pedicle instrumentation -two to three levels above and below -to obtain immediate corrective power, unfortunately at the expense of significant morbidity [5,11] . Major complications including death, permanent paralysis, pseudoarthrosis, proximal junctional failure and infection may affect up to 60% of treated patients and are largely dependent on age, degree of sagittal imbalance and medical comorbidities at the current state of knowledge [3][4][5][6]11] . In addition, there seems to be wide variability in revision rates among centers treating different volumes of patients [12] .…”

“…While the current scenario is dominated by the obsessive research of balance through the use of spinal osteotomies [7] , the next will see the research of lesser invasive methods of anterior and posterior reconstruction that would not be at the expense of obtaining a solid and lasting fusion [8] . Open questions are issues about costs and complications of this most complex aspect of clinical medicine [9][10][11] . Aim of this paper is to set the scene of current and future trends in adult spinal deformity (ASD) surgery by analysing the potentially most important recently published papers on the subject.…”

“…Eleven papers were included in the analysis because of their clinical relevance to the subject [2][3][4][5][6][7][8][9][10][11][12] . All of them are retrospective case series or reviews limiting the value of their evidence to lower levels.…”

Complication avoidance with pre-operative screening: insights from the Seattle spine team

“…Complication rates reported for these procedures range from 25 to 80 % [1,2]. Even for general spine surgery, intraoperative adverse event rates reported in the literature reach 10 % [3][4][5][6][7][8][9]. Complex spine surgery, defined as a surgical procedure requiring six or more levels of vertebral fusion, is typically used to correct adult lumbar scoliosis.…”