Perioperative Complications and Mortality After Spinal Fusions

Goz, Vadim; Weinreb, Jeffrey H.; McCarthy, Ian; Schwab, Frank; Lafage, Virginie; Errico, Thomas J.

doi:10.1097/brs.0b013e3182a62527

Cited by 94 publications

(41 citation statements)

References 27 publications

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“…[7][8] Regardless of the reason, during fiscal year 2013, the Medicare program reimbursed hospitals over $3.6 billion for spinal fusion surgery, making total spending on spinal fusion surgery one of the three highest admission outlays in the Medicare program; along with total knee arthroplasty and congestive heart failure. 9 A number of articles have reported on mortality and selected adverse events associated with patients undergoing spinal fusion surgery [10][11][12][13][14] and other studies have examined length of stay 8,15 and unplanned readmission after spinal surgery. [16][17] However, only a few of these studies used a national sample of spinal surgery patients in the United States 8,11,[13][14][15] each adverse event.…”

Section: Introductionmentioning

confidence: 99%

Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing Lumbar Spinal Fusion During Fiscal Year 2013

Culler

Jevsevar

Shea

et al. 2016

Spine

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Section: Introductionmentioning

confidence: 99%

Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing Lumbar Spinal Fusion During Fiscal Year 2013

Culler

Jevsevar

Shea

et al. 2016

Spine

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“…Goz and coworkers indicated that the mortality rates after spine surgery remained constant over a 10-year period. 9 Thoracic spine surgery had the highest death incidence (1.2%), followed by cervical (0.46%) and lumbar (0.14%). A similar pattern was observed in another database study, with the mortality incidence being 0.57%, 0.13%, and 0.11% for the thoracic, cervical, and lumbar regions, respectively.…”

Section: Discussionmentioning

confidence: 94%

Intraoperative Death During Cervical Spinal Surgery: A Retrospective Multicenter Study

Wang

Buser

Fish

et al. 2017

Global Spine Journal

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Study Design:A retrospective multicenter study.Objective:Routine cervical spine surgeries are typically associated with low complication rates, but serious complications can occur. Intraoperative death is a very rare complication and there is no literature on its incidence. The purpose of this study was to determine the intraoperative mortality rates and associated risk factors in patients undergoing cervical spine surgery.Methods:Twenty-one surgical centers from the AOSpine North America Clinical Research Network participated in the study. Medical records of patients who received cervical spine surgery from January 1, 2005, to December 31, 2011, were reviewed to identify occurrence of intraoperative death.Results:A total of 258 patients across 21 centers met the inclusion criteria. Most of the surgeries were done using the anterior approach (53.9%), followed by posterior (39.1%) and circumferential (7%). Average patient age was 57.1 ± 13.2 years, and there were more male patients (54.7% male and 45.3% female). There was no case of intraoperative death.Conclusions:Death during cervical spine surgery is a very rare complication. In our multicenter study, there was a 0% mortality rate. Using an adequate surgical approach for patient diagnosis and comorbidities may be the reason how the occurrence of this catastrophic adverse event was prevented in our patient population.

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“…[12-14] Such studies have found that age and comorbidity burden of patients undergoing spinal fusion has increased over the last decade. [12] However, the effects of age, specific comorbidities, and hospital characteristics on outcomes immediately following atlantoaxial fusion have not yet been quantified. Identifying and quantifying predictors of postoperative outcome can improve patient risk counseling for atlantoaxial fusion.…”

Section: Introductionmentioning

confidence: 99%

Predictors of outcomes and hospital charges following atlantoaxial fusion

et al. 2016

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Background Context Atlantoaxial fusion is used to correct atlantoaxial instability that is often secondary to traumatic fractures, Down syndrome, or rheumatoid arthritis. The effect of age and comorbidities on outcomes following atlantoaxial fusion is unknown. Purpose To better understand trends and predictors of outcomes and charges following atlantoaxial fusion and to identify confounding variables that should be included in future prospective studies. Study Design Retrospective analysis of data from the Nationwide Inpatient Sample (NIS), a nationally representative, all-payer database of inpatient diagnoses and procedures in the United States. Patient Sample We included all patients that underwent atlantoaxial fusion (International Classification of Disease, Ninth Revision, Clinical Modification code 81.01) between 1998-2011 that were 18 years or older at the time of admission. Outcome Measures Outcome measures included in-hospital charges, length of hospital stay (LOS), in-hospital mortality, and discharge disposition. Methods Predictors of outcome following atlantoaxial fusion were assessed using a series of univariable analyses. Those predictors with a p-value of less than 0.2 were included in the final multivariable models. Independent predictors of outcome were those that were significant at an alpha level of 0.05 following inclusion in the final multivariable models. Logistic regression was used to determine predictors of in-hospital mortality and discharge disposition whereas linear regression was used to determine predictors of hospital charges and LOS. Discharge weights were used to produce generalizable results. Results From 1998-2011, there were 8,914 hospitalizations recorded wherein atlantoaxial fusion was performed during the inpatient hospital stay. Of these hospitalizations, 8,189 (91.9%) met inclusion criteria. 62% of the study sample was white, while the majority of patients were either insured by Medicare (47.2%) or had private health insurance (35.6%). The most common comorbidity as defined by the NIS and the Elixhauser comorbidity index was hypertension (43.2%). The in-hospital mortality rate for the study population was 2.7% and the median LOS was 6.0 days. The median total charge (inflation adjusted) per hospitalization was $73,561. 48.9% of patients were discharged to home. Significant predictors of in-hospital mortality included increased age, emergent or urgent admissions, weekend admissions, congestive heart failure, coagulopathy, depression, electrolyte disorder, metastatic cancer, neurological disorder, paralysis, and non-bleeding peptic ulcer. Many of these variables were also found to be predictors of LOS, hospital charges, and discharge disposition. Conclusion This study found that older patients and those with greater comorbidity burden had greater odds of postoperative mortality and being discharged to another care facility, longer hospital length of stay, and incurred greater hospital charges following atlantoaxial fusion.

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Perioperative Complications and Mortality After Spinal Fusions

Abstract: N/A.

Cited by 94 publications

References 27 publications

Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing Lumbar Spinal Fusion During Fiscal Year 2013

Incremental Hospital Cost and Length-of-Stay Associated With Treating Adverse Events Among Medicare Beneficiaries Undergoing Lumbar Spinal Fusion During Fiscal Year 2013

Intraoperative Death During Cervical Spinal Surgery: A Retrospective Multicenter Study

Predictors of outcomes and hospital charges following atlantoaxial fusion

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