Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Schoenfeld, Andrew J.; Reamer, Elyse; Wynkoop, Emily I.; Choi, Hwajung; Bono, Christopher M.

doi:10.1007/s11999-014-4102-z

Cited by 27 publications

(14 citation statements)

References 59 publications

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“…Previous studies have identified age, sex, and certain comorbidities as risk factors that are most often associated with mortality during lumbar spine procedures. 4,23,28,33,34 Despite these reported risk factors, it is also recognized that mortality rates in lumbar spine surgeries are historically low overall, with one large-scale study estimating an overall mortality rate of 0.13% across all lumbar surgical patients in the United States between 2003 and 2012. 26 This same study identified older age, black race, male sex, liver disease, and congestive heart failure to be significantly associated with increased mortality rates.…”

Section: Mortalitymentioning

confidence: 99%

Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population

Martini¹,

Nistal²,

Deutsch³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe authors set out to conduct the first national-level study assessing the risks and outcomes for different lumbar fusion procedures in patients with opioid use disorders (OUDs) to help guide the future development of targeted enhanced recovery after surgery (ERAS) protocols for this unique population.METHODSData for patients with or without OUDs who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lateral transverse lumbar interbody fusion (LLIF) for lumbar disc degeneration (LDD) were collected from the 2013–2014 National (Nationwide) Inpatient Sample database. Multivariable logistic regression was implemented to analyze how OUD status impacted in-hospital complications, length of hospital stay, discharge disposition, and total charges by procedure type.RESULTSA total of 139,995 patients with LDD were identified, with 1280 patients (0.91%) also having a concurrent OUD diagnosis. Overall complication rates were higher in OUD patients (48.44% vs 31.01%, p < 0.0001). OUD patients had higher odds of pulmonary (p = 0.0006), infectious (p < 0.0001), and hematological (p = 0.0009) complications. Multivariate regression modeling of outcomes by procedure type showed that after ALIF, OUD patients had higher odds of nonhome discharge (p = 0.0007), extended hospitalization (p = 0.0002), and greater total charges (p = 0.0054). This analysis also revealed that OUD patients faced higher odds of complication (p = 0.0149 and p = 0.0471), extended hospitalization (p = 0.0439 and p = 0.0001), and higher total charges (p < 0.0001 and p < 0.0001) after PLIF and LLIF procedures, respectively.CONCLUSIONSObtaining a better understanding of the risks and outcomes that OUD patients face perioperatively is a necessary step toward developing more effective ERAS protocols for this vulnerable population. This study, which sought to characterize the outcome profiles for lumbar fusion procedures in OUD patients on a national level, found that this population tended to experience increased odds of complications, extended hospitalization, nonhome discharge, and higher total costs. Results from this study warrant future prospective studies to better the understanding of these associations and to further the development of better ERAS programs that may improve patient care and reduce cost burden.

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Section: Mortalitymentioning

confidence: 99%

Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population

Martini¹,

Nistal²,

Deutsch³

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Patient variables such as age, sex, and the number and type of medical comorbidities have been found to influence the risk of complications that include deep wound infection, cardiopulmonary complication, thromboembolic disease, pulmonary embolism, cerebrovascular accident, and neurological deficit. 12,23,28,29,36,37,39 The types of medical comorbidities that the RAT incorporates are diverse, ranging from cardiac dysfunction to psychiatric disorders. Psychiatric disorders are well established in the spine population, considering the high rate of depression in patients with back pain.…”

Section: Risk Assessment Toolmentioning

confidence: 99%

Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

Veeravagu¹,

Li²,

Swinney³

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEThe ability to assess the risk of adverse events based on known patient factors and comorbidities would provide more effective preoperative risk stratification. Present risk assessment in spine surgery is limited. An adverse event prediction tool was developed to predict the risk of complications after spine surgery and tested on a prospective patient cohort.METHODSThe spinal Risk Assessment Tool (RAT), a novel instrument for the assessment of risk for patients undergoing spine surgery that was developed based on an administrative claims database, was prospectively applied to 246 patients undergoing 257 spinal procedures over a 3-month period. Prospectively collected data were used to compare the RAT to the Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. Study end point was occurrence and type of complication after spine surgery.RESULTSThe authors identified 69 patients (73 procedures) who experienced a complication over the prospective study period. Cardiac complications were most common (10.2%). Receiver operating characteristic (ROC) curves were calculated to compare complication outcomes using the different assessment tools. Area under the curve (AUC) analysis showed comparable predictive accuracy between the RAT and the ACS NSQIP calculator (0.670 [95% CI 0.60–0.74] in RAT, 0.669 [95% CI 0.60–0.74] in NSQIP). The CCI was not accurate in predicting complication occurrence (0.55 [95% CI 0.48–0.62]). The RAT produced mean probabilities of 34.6% for patients who had a complication and 24% for patients who did not (p = 0.0003). The generated predicted values were stratified into low, medium, and high rates. For the RAT, the predicted complication rate was 10.1% in the low-risk group (observed rate 12.8%), 21.9% in the medium-risk group (observed 31.8%), and 49.7% in the high-risk group (observed 41.2%). The ACS NSQIP calculator consistently produced complication predictions that underestimated complication occurrence: 3.4% in the low-risk group (observed 12.6%), 5.9% in the medium-risk group (observed 34.5%), and 12.5% in the high-risk group (observed 38.8%). The RAT was more accurate than the ACS NSQIP calculator (p = 0.0018).CONCLUSIONSWhile the RAT and ACS NSQIP calculator were both able to identify patients more likely to experience complications following spine surgery, both have substantial room for improvement. Risk stratification is feasible in spine surgery procedures; currently used measures have low accuracy.

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“…The sex of a patient has previously been shown to have an impact on the outcome of a surgical intervention. [1][2][3][4][5][6][7][8][9][10] Women undergoing vascular surgery have been found to have higher mortality rates, more wound complications, greater need for blood transfusion, and increased length of stay. [1][2][3][4][5] In trauma surgery, male sex has been associated with increased mortality, length of stay, and complications.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women?

et al. 2019

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Background: Patient sex is known to affect outcomes following surgery. Prior studies have not specifically examined sex-stratified outcomes following spine surgery. The objective is to determine the differences between men and women in terms of 30-day complications following spine surgery.Methods: The National Surgical Quality Improvement Program database was queried for patients undergoing spine surgery from 2005 to 2014. Postoperative data were analyzed to determine the differences between men and women with regard to 30-day complications.Results: A total of 41 315 patients (49.0% women, 51% men) were analyzed. Men were more likely to have diabetes (P ¼ .004) and be active smokers (P , .001). Women were more likely to be taking steroids for chronic conditions (P , .001). Postoperatively, women were at increased risk for superficial surgical site infection, urinary tract infection, transfusions, and longer length of stay, whereas men were at increased risk of pneumonia and reintubation. On multivariate analysis, women were associated with urinary tract infections (odds ratio ¼ 2.17) and transfusions (odds ratio ¼ 1.63).Conclusions: Differences in complications are evident between men and women following spine surgery. These differences should be considered during preoperative planning and when consenting patients for surgery.Level of Evidence: 4

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Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Cited by 27 publications

References 59 publications

Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population

Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population

Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool

Postoperative Complications Following Orthopedic Spine Surgery: Is There a Difference Between Men and Women?

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