Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients

Lee, Michael J.; Konodi, Mark A.; Cizik, Amy M.; Bransford, Richard J.; Bellabarba, Carlo; Chapman, Jens R.

doi:10.1016/j.spinee.2011.11.008

Cited by 130 publications

(119 citation statements)

References 13 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…Surgery for adult spinal deformity is associated with higher complication rates than for childhood scoliosis. 1,14,15 Higher rates of perioperative complications and revision surgery create a challenge for the management of adult spinal deformity. 1,14,15,19 Older age, medical comorbidities, and surgical invasiveness have been considered significant risk factors for perioperative complications after spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…1,14,15,19 Older age, medical comorbidities, and surgical invasiveness have been considered significant risk factors for perioperative complications after spinal surgery. 14,15 Although PT UIV is a more invasive procedure than DT UIV, we found no clear difference in the incidence of revision surgery between the 2 groups.…”

Section: Discussionmentioning

confidence: 99%

“…Types of osteotomy in both groups were not different (p = 0.411). Pedicle subtraction osteotomy was used in 22.4% (15) of the patients in the DT group and 18.2% (4) of those in the PT group. The number of interbody fusions was similar in the 2 groups (p = 0.923).…”

Section: Surgical Procedures and Revision Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae

Maruo

Racine

et al. 2013

SPI

141

View full text Add to dashboard Cite

Object Proximal junctional kyphosis (PJK) is a common and significant complication after corrective spinal deformity surgery. The object of this study was to compare—based on clinical outcomes, postoperative proximal junctional kyphosis rates, and prevalence of revision surgery—proximal thoracic (PT) and distal thoracic (DT) upper instrumented vertebra (UIV) in adults who underwent spine fusion to the sacrum for the treatment of spinal deformity. Methods In this retrospective study the authors evaluated clinical and radiographic data from consecutive adults (age > 21 years) with a deformity treated using long instrumented posterior spinal fusion to the sacrum in the period from 2007 to 2009. The PT group included patients in whom the UIV was between T-2 and T-5, whereas the DT group included patients in whom the UIV level was between T-9 and L-1. Perioperative surgical data were compared between the PT and DT groups. Additionally, segmental, regional, and global spinal alignments, as well as the sagittal Cobb angle at the proximal junction, were analyzed on preoperative, early postoperative, and final standing 36-in. radiographs. Patient-reported outcome measurements (visual analog scale, Scoliosis Research Society Patient Questionnaire-22, Oswestry Disability Index, and the 36-Item Short-Form Health Survey) were compared. Results Eighty-nine patients, 22 males and 67 females, had a minimum follow-up of 2 years, and thus were eligible for participation in this study. Sixty-seven patients were in the DT group and 22 were in the PT group. Operative time (p = 0.387) and estimated blood loss (p < 0.05) were slightly higher in the PT group. The overall rate of revision surgery was 48.0% and 54.5% in the DT and PT groups, respectively (p = 0.629). The prevalence of PJK according to radiological criteria was 34% in the DT group and 27% in the PT group (p = 0.609). The percent of patients with PJK that required surgical correction (surgical PJK) was 11.9% (8 of 67) in the DT group and 9.1% (2 of 22) in the PT group (p = 1.0). The onset of surgical PJK was significantly earlier than radiological PJK in the DT group (p < 0.01). The types of PJK were different in the PT and DT groups. Compression fracture at the UIV was more prevalent in the DT group, whereas subluxation was more prevalent in the PT group. Postoperatively, the PT group had less thoracic kyphosis (p = 0.02), less sagittal imbalance (p < 0.01), and less pelvic tilt (p = 0.04). In the DT group, early postoperative radiographs demonstrated that the proximal junctional angle of patients with surgical PJK was greater than in those without PJK and those with radiological PJK (p < 0.01). Clinical outcomes were significantly improved in both groups, and there was no significant difference between the groups. Conclusions Both PT and DT UIVs improve segmental and global sagittal plane alignment as well as patient-reported quality of life in those treated for adult spinal deformity. The prevalence of PJK was not different in the PT and DT groups. However, compression fracture was the mechanism more frequently observed with DT PJK, and subluxation was the mechanism more frequently observed in PT PJK. Strategies to avoid PJK may include vertebral augmentation to prevent fracture at the DT spine and mechanical means to prevent vertebral subluxation at the PT spine.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae

Maruo

Racine

et al. 2013

SPI

141

View full text Add to dashboard Cite

show abstract

“…In the past, several significant risk factors for medical complications in spine surgery were identified utilizing multivariate analysis [5][6][7]. However, a risk stratification tool that is easy to integrate into clinical practice has been missing.…”

Section: Electronic Supplementary Materialsmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

“…13 Lee et al carefully documented complications from 1745 patients enrolled in a spine registry at the University of Washington and was able to provide risk adjustment analysis by including surgical invasiveness and other factors that are difficult to obtain from administrative databases, including the national inpatient sample. 9 …”

Section: Complicationsmentioning

confidence: 99%

The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Ghogawala

Shaffrey

Asher

et al. 2013

SPI

View full text Add to dashboard Cite

Object. There is significant practice variation and considerable uncertainty among payers and other major stakeholders as to whether many surgical treatments are effective in actual US spine practice. The aim of this study was to establish a multicenter cooperative research group and demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures using prospectively collected patient-reported outcome measures.Methods. An observational prospective cohort study was conducted at 13 US academic and community sites. Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis were included. Patients completed the 36-item Short-Form Survey Instrument (SF-36), Oswestry Disability Index (ODI), and visual analog scale (VAS) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: 125 patients with lumbar disc herniation, and 35 with lumbar spondylolisthesis. All patient data were entered into a secure Internet-based data management platform.Results. Of 249 patients screened, there were 198 enrolled over 1 year. The median age of the patients was 45.0 years (49% female) for lumbar discectomy (n = 148), and 58.0 years (58% female) for lumbar spondylolisthesis (n = 50). At 30 days, 12 complications (6.1% of study population) were identified. Ten patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis required reoperation. The overall follow-up rate for the collection of patient-reported outcome data over 1 year was 88.3%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, VAS, and SF-36 scores (p ≤ 0.0002), which persisted over the 1-year follow-up period (p < 0.0001). By the 1-year follow-up evaluation, more than 80% of patients in each cohort who were working preoperatively had returned to work.Conclusions. It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice. Clinical trial registration no.: 01220921 (ClinicalTrials.gov). (http://thejns.org/doi/abs/10.3171/2013

show abstract

Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients

Cited by 130 publications

References 13 publications

Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae

Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae

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

The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Contact Info

Product

Resources

About