Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients

Street, John; Lenehan, Brian; DiPaola, Christian P.; Boyd, Michael; Kwon, Brian K.; Paquette, Scott; Dvorak, Marcel F.; Rampersaud, Y. Raja; Fisher, Charles G.

doi:10.1016/j.spinee.2011.12.003

Cited by 164 publications

(106 citation statements)

References 12 publications

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“…These findings are generally consistent with a review by Deyo et al [8]. Our overall mortality rates are comparable to those found by Street et al [19] and in agreement with a systematic review of the literature reporting mortality rates for cervical spine and lumbar spine surgery \1 %. In disagreement with Malter et al [20] we demonstrated that fusion especially PLIF was associated with lower rates of iterative surgery than decompression alone.…”

Section: Resultssupporting

confidence: 93%

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

2012

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Purpose The purpose is to study rates, trends, geographic variations and outcome of lumbar spine surgery in the Belgian population during the last decade. Methods This is a retrospective cohort study using administrative data of the largest Belgian sickness fund from January 1, 2000 through December 31, 2009. Cases included lumbar laminectomy, combined discectomy and fusion, posterior interarticular fusion, anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and standard discectomy. The main outcome measures were age-and sex-adjusted rates of lumbar spine surgery, 1-year mortality, 1-year iterative surgery, no return to work (RTW) rate 1 year after surgery and length of hospital stay. Multivariate logistic regression analysis was used to determine the association between age, sex, geographic region, type of surgery, year of intervention and duration of pre-operative sick leave on outcome. Results Spine surgery rates rose 44 % from 2001 through 2009 and data for 2009 showed twofold variations in spine surgery rates among 10 Belgian provinces. Reported 1-year mortality varied from 0.6 to 2.5 % among surgical procedures performed in 2008. The overall 5-year reoperation rate was 12 %. RTW rates 1 year after standard discectomy, ALIF, PLIF and combined discectomy and fusion for the follow-up sample of 2008 were 14.4, 22.7, 26.1 and 30.6 %, respectively. The median length of hospital stay significantly decreased throughout the decade. Type of surgery and geographic region were significantly related to patient outcomes. Conclusions Regional variations highlight professional uncertainty and controversy. The study results point to the need for peer comparisons and surgeon feedback.

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Section: Resultssupporting

confidence: 93%

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

2012

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“…Our methods for prospectively collecting adverse event data have been previously published. 19,27,28 All patients underwent decompression and pedicle screw instrumentation through either a standard midline or Wiltse approach. The standard technique with either approach at our institution is to perform a complete facetectomy of at least 1 of the facets and insert the interbody cage through the foramen (transforaminal lumbar interbody fusion) while visualizing and protecting the exiting and traversing nerve roots.…”

Section: Methodsmentioning

confidence: 99%

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Street

Glennie

Dea

et al. 2016

SPI

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OBJECTIVE The objective of this study was to determine if there is a significant difference in surgical site infection (SSI) when comparing the Wiltse and midline approaches for posterior instrumented interbody fusions of the lumbar spine and, secondarily, to evaluate if the reoperation rates and specific causes for reoperation were similar for both approaches. METHODS A total of 358 patients who underwent 1- or 2-level posterior instrumented interbody fusions for degenerative lumbar spinal pathology through either a midline or Wiltse approach were prospectively followed between March 2005 and January 2011 at a single tertiary care facility. A retrospective analysis was performed primarily to evaluate the incidence of SSI and the incidence and causes for reoperation. Secondary outcome measures included intraoperative complications, blood loss, and length of stay. A matched analysis was performed using the Fisher's exact test and a logistic regression model. The matched analysis controlled for age, sex, comorbidities, number of index levels addressed surgically, number of levels fused, and the use of bone grafting. RESULTS All patients returned for follow-up at 1 year, and adverse events were followed for 2 years. The rate of SSI was greater in the midline group (8 of 103 patients; 7.8%) versus the Wiltse group (1 of 103 patients; 1.0%) (p = 0.018). Fewer additional surgical procedures were performed in the Wiltse group (p = 0.025; OR 0.47; 95% CI 0.23–0.95). Proximal adjacent segment failure requiring reoperation occurred more frequently in the midline group (15 of 103 patients; 14.6%) versus the Wiltse group (6 of 103 patients; 5.8%) (p = 0.048). Blood loss was significantly lower in the Wiltse group (436 ml) versus the midline group (703 ml); however, there was no significant difference between the 2 groups in intraoperative complications or length of stay. CONCLUSIONS The patients who underwent the Wiltse approach had a decreased risk of wound breakdown and infection, less blood loss, and fewer reoperations than the midline patients. The risk of adjacent segment failure in short posterior constructs is lower with a Wiltse approach.

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“…Despite diligent patient selection and preoperative screening and optimization, elective spinal procedures are still potentially associated with morbidity. 27 Ultimately, risk calculations may be insufficient to assess the overall health of a patient, as two patients with the same preoperative risk factors (i.e., age, American Society of Anesthesiologists score, comorbidities, and disease stage) are often in clearly different stages of health. Surgeons will often "eyeball" patients to see if they are fit for surgery, and surgeons make operative decisions regardless of risk stratification.…”

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confidence: 99%

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

Zakaria¹,

Schultz

Mossa-Basha

et al. 2015

FOC

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OBJECT Improved objective assessments of perioperative risk after spine surgery are necessary to decrease postoperative morbidity and mortality rates. Morphometric analysis has proven utility in predicting postoperative morbidity and mortality in surgical disciplines. The aim of the present study was to evaluate whether morphometrics can be applied to the cases of patients undergoing lumbar spine surgery. METHODS The authors performed a retrospective review of the perioperative course of 395 patients who underwent lumbar surgery at their institution from 2013 to 2014. Preoperative risk factors such as age, diabetes, smoking, coronary artery disease, and body mass index (BMI) were recorded. Preoperative MRI was used to measure the psoas muscle area at the L-4 vertebra and paraspinal muscle area at the T-12 vertebra. Primary outcomes included unplanned return to the operating room, 30- and 90-day readmissions, surgical site infection, wound dehiscence, new neurological deficit, deep vein thrombosis, pulmonary embolism, myocardial infarction, urinary tract infection, urinary retention, hospital-acquired pneumonia, stroke, and prolonged stay in the intensive care unit. RESULTS The overall rate of adverse events was 30%, the most common event being urinary retention (12%). Greater age (p = 0.015) and tobacco usage (p = 0.026) were both significantly associated with complications for all patients, while diabetes, coronary artery disease, and high BMI were not. No surgery-related characteristics were associated with postoperative morbidity, including whether surgery required instrumentation, whether it was a revision, or the number of vertebral levels treated. Using multivariate regression analysis, male and female patients with the lowest psoas tertile had an OR of 1.70 (95% CI 1.04–2.79, p = 0.035) for having postoperative complications. Male patients in the lowest psoas tertile had an OR of 2.42 (95% CI 1.17–5.01, p = 0.016) for having a postoperative complication. The paraspinal muscle groups did not provide any significant data for postoperative morbidity, even after multivariate analysis. CONCLUSIONS The morphometric measurement of psoas muscle size may be a sensitive predictive tool compared with other risk factors for perioperative morbidity in male patients undergoing lumbar surgery.

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Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients

Cited by 164 publications

References 12 publications

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine

Morphometrics as a predictor of perioperative morbidity after lumbar spine surgery

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