The influence of comorbidity on the risks and benefits of spine surgery for degenerative lumbar disorders

Abstract

Purpose The ageing of the population will see a growing number of patients presenting for spine surgery with appropriate indications but numerous medical comorbidities. This complicates decision-making, requiring that the likely benefit of surgery (outcome) be carefully weighed up against the potential risk (complications). We assessed the influence of comorbidity on the risks and benefits of spine surgery. Methods 3,549/4,053 patients with degenerative lumbar disorders, undergoing surgery with the goal of pain relief, completed the multidimensional Core Outcome Measures Index (COMI; scored 0-10) before and 12 months after surgery. At 12 months postoperatively, they also rated the global treatment outcome and their satisfaction with care. Using the Eurospine Spine Tango Registry, surgeons documented surgical details, American Society of Anesthesiologists comorbidity (ASA) grades and perioperative surgical and general complications. Results 29.0 % patients were rated as ASA1 (normal healthy), 45.7 % as ASA2 (mild/moderate systemic disease), 24.9 % as ASA3 (severe), and just 0.4 % as ASA4 (life-threatening). In going from ASA1 to ASA3 (ASA4 group too small), surgical complications increased significantly from 5.0 to 14.5 % and general complications increased from 2.9 to 15.7 %; 12-month outcomes showed a corresponding decline, with a good global outcome being reported by 79 % ASA1 patients, 76 % ASA2, and 68 % ASA3. Satisfaction with treatment was 87, 85, and 79 %, respectively, and reduction in COMI was 4.2 ± 2.9, 3.7 ± 3.0, and 3.4 ± 3.0 points, respectively. Multiple regression analysis revealed a significant (p \ 0.0001) independent effect of ASA grade on both complications and outcome. Conclusion The negative impact of comorbidity on the outcome of spine surgery has not been well investigated/ quantified to date. The ASA grade may be helpful in producing algorithms for decision-making and preoperative counselling regarding the corresponding risks and benefits of surgery.

Patient-Rated Outcomes of Lumbar Fusion in Patients With Degenerative Disease of the Lumbar Spine

“…30 In a large series comprising more than 3500 patients with degenerative lumbar disorders, it was shown that the ASA grade has an independent effect on both complications and outcome. 1 Although age was associated with an increase in comorbidity, the effect of comorbidity on complications and outcome was not just an effect of age. 1 Age positively correlated with an increase in complication risk in a prospective assessment of 87 consecutive patients undergoing elective surgery for degenerative thoracolumbar disorders, 31 although it was not clear whether age was simply a surrogate measure of comorbidity.…”

“…1 Although age was associated with an increase in comorbidity, the effect of comorbidity on complications and outcome was not just an effect of age. 1 Age positively correlated with an increase in complication risk in a prospective assessment of 87 consecutive patients undergoing elective surgery for degenerative thoracolumbar disorders, 31 although it was not clear whether age was simply a surrogate measure of comorbidity. In a large retrospective analysis of 174 patients older than 70 years and 311 patients younger than 65 years of age, multiple regression analysis revealed increased age as important risk factor for perioperative complications in patients undergoing lumbar spinal fusion.…”

“…Age and associated comorbidities represent important determinants of perioperative complications, in particular with extensive surgical spinal procedures. [1][2][3][4][5] There is a general reluctance to consider spinal fusion in older patients, especially in the geriatric population, given the increased likelihood of complications, greater costs, and longer hospital stay. Despite numerous advances in surgical techniques and perioperative care, the outcome of spinal fusion might be expected to be poorer in the elderly due to their lower bone quality and increased susceptibility to complications.…”

Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database

“…3 The literature has also shown the ASA class to predict patient satisfaction following lumbar spine surgery. 15 In a study by Mannion and colleagues, the percentage of patients satisfied with surgery was 87%, 85%, and 79% for preoperative ASA classes I, II, and III, respectively, indicating that higher ASA classes were associated with lower percentages of patient satisfaction. In contrast to these studies, our study focused only on patients with lumbar spondylolisthesis; thus, the differing pathology-specific factors may have contributed to the differences reported herein.…”

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

“…Schoenfeld et al [1] identified cardiac disease and an ASA score of > 2 as independent risk factors for medical complications after spine surgery. Mannion et al [17] reported that an increasing ASA score is associated with a higher incidence of perioperative complications. They concluded that the ASA score might be used in preoperative counseling of patients about their perioperative risk.…”