Frequency and Implications of Concurrent Complications Following Adult Spinal Deformity Corrective Surgery

Abstract

Study Design. Retrospective review. Objective. Identify co-occurring perioperative complications and associated predictors in a population of patients undergoing surgery for adult spinal deformity (ASD). Summary of Background Data. Few studies have investigated the development of multiple, co-occurring complications following ASD-corrective surgery. Preoperative risk stratification may benefit from identification of factors associated with multiple, co-occurring complications. Methods. Elective ASD patients in National Surgical Quality Improvement Program (NSQIP) 2005 to 2016 were isolated; rates of co-occurring complications and affected body systems were assessed via cross tabulation. Random forest analysis identified top patient and surgical factors associated with complication cooccurrence, using conditional inference trees to identify significant cutoff points. Binary logistic regression indicated effect size of top influential factors associated with complication co-occurrence at each factor's respective cutoff point. Results. Included: 6486 ASD patients. The overall perioperative complication rate was 34.8%; 28.5% of patients experienced one complication, 4.5% experienced two, and 1.8% experienced 3þ.Overall, 11% of complication co-occurrences were pulmonary/ cardiovascular, 9% pulmonary/renal, and 4% integumentary/ renal. By complication type, the most common co-occurrences were transfusion/urinary tract infection (UTI) (24.3%) and transfusion/pneumonia (17.7%). Surgical factors of operative time !400 minutes and fusion !9 levels were the strongest factors associated with the incidence of co-occurring complications, followed by patient-specific variables like American Society of Anesthesiologists (ASA) physical status classification grade !2 and age !65 years. Regression analysis further showed associations between increasing complication number and longer length of stay (LOS), (R 2 ¼ 0.202, P < 0.001), non-home discharge (R 2 ¼ 0.111, P ¼ 0.001), and readmission (R 2 ¼ 0.010, P < 0.001). Conclusion. For surgical ASD patients, the overall rate of cooccurring perioperative complications was 6.3%. Body systems most commonly affected by complication co-occurrences were pulmonary and cardiovascular, and common co-occurrences included transfusion/UTI (24.3%) and transfusion/pneumonia (17.7%). Increasing number of perioperative complications was associated with greater LOS, non-home discharge, and readmission, highlighting the importance of identifying risk factors for complication co-occurrences.

The Case for Operative Efficiency in Adult Spinal Deformity Surgery

“…Longer OR time was also associated with an increased rate of postoperative minor complications ( P =0.001), but was not related to the rate of major complications. These results are supported by multiple previous studies 1,3,24–31 . Lee et al 25 found that OR time was the most correlated to morbidity with an odds ratio of 3.5 ( P <0.0001).…”

“…These results are supported by multiple previous studies. 1,3,[24][25][26][27][28][29][30][31] Lee et al 25 found that OR time was the most correlated to morbidity with an odds ratio of 3.5 (P < 0.0001).…”

Frequency and predictors of complication clustering within 30 days of spinal fusion surgery: a study of children with neuromuscular scoliosis

“…Complications that cluster can lead to increased morbidity and may have a significant impact on hospital length of stay. Bortz et al [ 5 ] demonstrated a 6% rate of concurrent complications in adults undergoing correction for adult spinal deformity, but there have been no studies examining co-occurring or concurrent post-fusion complications among pediatric patients with neuromuscular scoliosis.…”

Patient-Centered Outcomes Following Prone Lateral Single-Position Approach to Same-Day Circumferential Spine Surgery

“…17 Similarly, these procedures have also demonstrated high rates of complications both perioperatively and in the long term, with elevated rates of complications and revision. 18 Therefore, surgeons have been investigating new techniques to mitigate the elevated risk profile of these invasive surgeries while still achieving the same clinical and radiographic outcomes. A particularly attractive technique that has gained popularity as of late is the single-position approach to circumferential fusion.…”

“…Yet, despite the added benefits of this strategy, some patients have more focal deformity and degeneration in the thoracolumbar spine, which may only require the fusion of one to three levels to address the root of their symptomatology 17 . Similarly, these procedures have also demonstrated high rates of complications both perioperatively and in the long term, with elevated rates of complications and revision 18 . Therefore, surgeons have been investigating new techniques to mitigate the elevated risk profile of these invasive surgeries while still achieving the same clinical and radiographic outcomes.…”