Incidence of Respiratory Complications Following Lumbar Spine Surgery

Abstract

Background: The purpose of this study is to assess the incidence, risk factors for, and types of respiratory complications occurring in patients undergoing lumbar spine surgery.Methods: Patients undergoing various lumbar spine surgeries from 2007 to 2014 were identified using the PearlDiver patient record database from the nationwide insurance provider Humana Inc. Patient records were analyzed using International Classification of Diseases, Ninth Revision codes and Current Procedural Terminology codes to determine the incidence of pneumonia, pleural effusion, pulmonary collapse, and acute respiratory failure for each procedure type. The incidence of these complications in patients with the risk factors diabetes mellitus, chronic obstructive pulmonary disease (COPD), and smoking was also examined.Results: A total of 64,891 patients (33,280 females; 31,611 males) within the Humana database underwent various lumbar procedures from 2007 to 2014. The overall incidence of respiratory complications in patients undergoing lumbar procedures was 5.7% (n ¼ 3694) within 1 month of having the procedure. Pulmonary collapse was the most common complication with an incidence of 4.3% (n ¼ 2792), followed by pneumonia 1.98% (n ¼ 1285), acute respiratory failure 1.97% (n ¼ 1279), and pleural effusion 1.6% (n ¼ 1048). For each respiratory complication studied, single level discectomy had the lowest complication rate and multilevel anterior lumbar interbody fusion had the highest complication rate. The incidence of each individual respiratory complication was higher in patients who had a history of smoking, COPD, or diabetes mellitus than it was in patients with none of these 3 risk factors (P , .01). Conclusion:The results of this study show that patients who have a history of smoking, COPD, or diabetes mellitus are at a greater risk for respiratory complications following lumbar spine surgery. These findings are useful for patient selection, clinical decision-making, and preoperative counseling.

Cigarette smoking and complications in elective thoracolumbar fusions surgery: An analysis of 58,304 procedures

“…It would seem reasonable to assume that smoking is associated with significant pulmonary complications. Several authors have indeed found a correlation between smoking and postoperative pulmonary complications in patients undergoing lumbar fusions[ 9 ] and in adults undergoing spinal deformity surgery. [ 34 ] This relationship, however, has not been confirmed by all authors: Bohl et al could not confirm the association between smoking and postoperative pneumonia and Jules-Elysee et al did not find an association between smoking and the development of pulmonary radiographic abnormalities in patients undergoing anterior-posterior thoracic lumbar fusions.…”

“…[ 3 4 ] The results of prior studies on the association between cigarette smoking and postoperative complications have been conflicting. While some of these studies revealed increased 30-day readmission rates, SSI,[ 5 6 7 ] perioperative transfusion risks,[ 8 ] deep venous thrombosis (DVT),[ 5 ] and pulmonary complications,[ 9 ] others have not. [ 3 10 11 12 13 14 15 ] There are few studies explicitly addressing perioperative complications in smokers following thoracolumbar fusion surgeries, and the studies that do exist are most commonly derived from a small cohort of patients from a single institution.…”

Regional Anesthesia in Spinal Surgery: Could it be the Solution for Difficult Intubation

“…The rate of atelectasis and other postoperative pulmonary complications, which are enhanced by general anesthesia, significantly decreases with epidural anesthesia and analgesia ( 14 ). Decreased functional residual capacity, forced vital capacity and prone positioning lead to atelectasis ( 15 ).…”

“…Decreased functional residual capacity, forced vital capacity and prone positioning lead to atelectasis ( 15 ). Studies reported that the incidence of atelectasis in postoperative period is up to 50%, followed by infiltrate, lobar collapse and pneumonia in patients who received general anesthesia ( 14 , 15 ).…”

Spine Surgery Patients’ Perceptions of Postoperative Pulmonary Complications

“…Postoperative pulmonary complications (PPCs) including pneumonia, atelectasis, respiratory failure, and exacerbations of underlying chronic lung disease, result in prolonged hospital stays (Murgai et al, 2018). About one in five patients with PPCs die within 30 days of PPC development (Miskovic & Lumb, 2017; Norris et al, 2019; Ramachandran et al, 2011; Smetana, 2009).…”