Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study

Abstract

BackgroundsRare study has been conducted to detect risk factors of perioperative complications, which are closely related to preoperative status of the patients and surgical stress. The aim of this study is to detect these relationships in degenerative scoliosis (DS) patients.MethodsPerioperative complications of 226 cases with DS (56 males and 170 females; 65.5 ± 8.1 years old), who accepted posterior fusion in our hospital from January, 2013 to July, 2017, were retrospectively reviewed. Potential risk factors were first compared between patients with or without perioperative complications using student t test or Chi-squared test. Then, the unevenly distributed variables between the two groups were analyzed with binary logistic regression model.ResultsAll patients separately underwent decompression with short limited instrumentation (116, 51.3%) or with long instrumentation for correction (110, 48.7%). The mean operation duration (OD) was 216.9 ± 64.2 min and the average amount of bleeding was 587.4 ± 357.2 ml. 44 cases (19.5%)suffered from the complications during the perioperative phase, including incision complications (5.3%), urinary infection (3.5%), dura tears/cerebrospinal fluid (CSF) leakages (3.5%) and new neurological deficits (2.7%). Hospital stay was significantly extended for the complications (p < 0.001). Univariate analysis showed that OD (p < 0.001), bleeding (p = 0.014), American Standards Association (ASA) grade > 2 (p = 0.011) and RBC transfusion≥4 U(p = 0.028) were associated with these complications. Multivariate logistic regressions revealed that only ASA grade > 2(p = 0.011, Odds Ratio[OR] = 4.104, 95% Confidence Interval[CI] = 1.413~ 11.917) and OD (p = 0.013, OR = 2.697, 95% CI = 1.233~ 5.899) were the independent risk factors.ConclusionsThe high morbidity of perioperative complications for posterior spinal fusion would significantly extend hospital stay of DS patients. It was independently related to higher ASA grade and longer OD.

Factors and Predictive Model Associated With Perioperative Complications After Long Fusion in the Treatment of Adult Non-Degenerative Scoliosis

“…The incidence of perioperative complications in our study (13.4%) was less than what was reported in a previous study (19.5%) [18]. Additionally, coronal and sagittal imbalance is more common in degenerative scoliosis than in non-degenerative adult scoliosis [4].…”

“…Owing to the fact that most of our patients were fairly young, there was relatively little data on history of lumbar operation, previous medication use, or whether there were any age-associated comorbidities such as diabetes and osteoporosis, some of which could be potential risk factors for ADS. Several studies have reported a direct correlation between parameters such as the ASA grade, Cobb angle, total operation time, PT, level of fusion, length of hospital stay, staging, multiple surgeries and the incidence of perioperative complications in ADS [9,18,[24][25][26]. However, further research is needed to identify the risk factors for perioperative complications in adult non-degenerative scoliosis.…”

Surgical Risk Assessment and Prevention in Elderly Spinal Deformity Patients

“…Extended operative time is a known factor correlating with postoperative complications in elderly patients undergoing lumbar spine surgery and patients with degenerative lumbar scoliosis. 19,90,91 In adult spinal deformity surgery, operative time was more predictive of surgical outcomes than operative complexity (ie, increased levels fused, presence of interbody fusions, osteotomies, and pelvic fixation). 47 Procedural time in excess of 309 minutes was associated with increased complication development for patients with spinal arthrodesis analyzed from NSQIP between 2005 and 2010.…”

Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis

“…Owing to the fact that most of our patients were relatively young, there was relatively little data on history of lumbar operation, previous medication use, or whether there were any ageassociated comorbidities such as diabetes and osteoporosis, some of which could be potential risk factors for ADS. Several studies have reported a direct correlation between parameters such as the ASA grade, Cobb angle, total operation time, PT, level of fusion, LOS, staging, multiple surgeries and the incidence of perioperative complications in ADS [9,[19][20][21][22]. However, further research is needed to identify the risk factors for perioperative complications in adult non-degenerative scoliosis.…”

“…Patients were divided into two groups based on whether they had any perioperative complications: without perioperative complication group (125) and with perioperative complications group (21). The results of univariate analysis investigating the relationships between baseline/ surgical characteristics and perioperative complications are shown in Tables 1 and 2.…”