Operative Time is an Independent Risk Factor for Complications in Adult Spinal Deformity Surgery

Eastlack, Robert

doi:10.32474/osmoaj.2018.01.000124

Cited by 2 publications

(2 citation statements)

References 26 publications

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“…Prolonged operative time has been tied to increased rates of complications across multiple surgical specialties, 41 including degenerative spine surgery 42 and ASD surgery specifically. 43 While few studies in the literature investigate the impact of TXA on operative time for complex spine and deformity surgery, the limited data suggests TXA may be able to reduce operative time. A meta-analysis by Hui et al 44 investigated the effect of TXA on operative time among 1947 spine patients (from 29 studies).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Systemic Tranexamic Acid on Hypercoagulable Complications and Perioperative Outcomes Following Three-Column Osteotomy for Adult Spinal Deformity

Haddad

Ames

Safaee

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: Thoracolumbar 3-column osteotomy (3CO) is a powerful technique for correction of rigid adult spinal deformity (ASD). However, it can be associated with high-volume blood loss. This study seeks to investigate the efficacy and safety of tranexamic acid (TXA) in 3CO ASD patients. Methods: ASD patients who underwent 3CO from 2006 to 2019 were retrospectively reviewed. Outcomes were compared between TXA and non-TXA patients, and TXA doses. Results: A total of 365 ASD patients were included: 181 TXA and 184 non-TXA. The mean age was 64.6 years and 60.5% were female. Operative time was shorter in the TXA group (295.6 vs 320.2 minutes, P < .001). However, TXA was not associated with shorter operative time (β = −6.5 minutes, 95% CI −29.0 to 15.9, P = .567) after accounting for surgeon experience. There was no difference in blood loss (2020.2 vs 1914.1 mL, P = .437) between groups. Overall complications (37.0% vs 33.2%, P = .439), including hypercoagulable (2.2% vs 3.8%, P = .373) and cardiac (13.3% vs 7.1%, P = .050) complications were similar between groups. TXA was not independently associated with blood loss or TXA-related complications. Both groups had comparable intensive care unit (2.5 vs 2.0 days, P = .060) and hospital (8.9 vs 8.2 days, P = .190) stays. There were no differences in outcomes between TXA dosing subgroups. Conclusions: Systemic TXA use during 3CO for ASD surgery was not associated with decreased blood loss. TXA patients had shorter operative times, but this was driven mainly by surgeon experience on multivariate analysis. Routine use of TXA is safe and does not increase the incidence of hypercoagulable complications even at high doses.

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Section: Discussionmentioning

confidence: 99%

The Effect of Systemic Tranexamic Acid on Hypercoagulable Complications and Perioperative Outcomes Following Three-Column Osteotomy for Adult Spinal Deformity

Haddad

Ames

Safaee

et al. 2020

Global Spine Journal

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“…Increasing operative time has been shown to be associated with poor 30-day outcomes in adult spinal deformity surgery. [15][16][17] An increasing operative time may be considered a proxy of case-complexity or the occurrence of certain intraoperative complications thus requiring these patients to continued care in a high-acuity surveillance environment such as in the ICU. While the aforementioned factors were associated with an ICU admission, it is important to relate that the only significant predictors for a prolonged ICU stay of more than 2 days were preoperative ventilator dependence, nutritional support, and undergoing an anterior and/or combined fusion.…”

Section: Discussionmentioning

confidence: 99%

Intensive Care Unit Admission Following Surgery for Pediatric Spinal Deformity: An Analysis of the ACS-NSQIP Pediatric Spinal Fusion Procedure Targeted Dataset

Malik

Kim

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort. Objective: To understand which patient and surgical factors are predictive of an increased odds of undergoing an admission and a prolonged stay >2 days in an intensive care unit (ICU) following corrective surgery for pediatric deformity. Methods: The 2016 American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric Spinal Fusion Procedure Targeted database records, merged with original 2016 ACS-NSQIP Pediatric file variables, were used for this study. Univariate and multivariate analyses were used to identify independent risk factors associated with admission, as well as a prolonged length of stay in the ICU following surgery. Results: A total of 1398 (39.5%) patients required an ICU admission following the procedure—out of whom 416 (29.8%) stayed for more than 2 days. Following adjusted analysis, patient and surgical factors independently associated with an ICU admission were black/African American versus white race, anterior fusion, combined fusion, nonidiopathic scoliosis, preoperative ventilator dependence, asthma, having structural pulmonary abnormality, developmental delay, having a neuromuscular disorder, requiring nutritional support and a total operative time >270 minutes. The only significant factors associated with a prolonged length of ICU stay >2 days were preoperative ventilator dependence, nutritional support requirement, and undergoing anterior or combined fusion. Conclusions: This study is the first of its kind to identify significant patient- and procedure-level factors associated with an ICU admission, and also explores predictors for a prolonged stay in the ICU. Surgeons can use this data to preoperatively counsel families and ensure postoperative course of care is appropriately planned ahead of time.

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Operative Time is an Independent Risk Factor for Complications in Adult Spinal Deformity Surgery

Cited by 2 publications

References 26 publications

The Effect of Systemic Tranexamic Acid on Hypercoagulable Complications and Perioperative Outcomes Following Three-Column Osteotomy for Adult Spinal Deformity

The Effect of Systemic Tranexamic Acid on Hypercoagulable Complications and Perioperative Outcomes Following Three-Column Osteotomy for Adult Spinal Deformity

Intensive Care Unit Admission Following Surgery for Pediatric Spinal Deformity: An Analysis of the ACS-NSQIP Pediatric Spinal Fusion Procedure Targeted Dataset

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