Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors

Abstract

Study design Analysis of the Nationwide Inpatient Sample (NIS) from 1998 to 2008.Objective To analyze the most recent available and nationally representative data for risk factors contributing to in-hospital mortality after primary lumbar spine fusion. Summary of background data The total number of lumbar spine fusion surgeries has increased dramatically over the past decades. While the field of spine fusion surgery remains highly dynamic with changes in perioperative care constantly affecting patient care, recent data affecting rates and risk for perioperative mortality remain very limited. Methods We obtained the NIS from the Hospital cost and utilization project. The impact of patient and health care system related demographics, including various comorbidities as well as postoperative complications on the outcome of in-hospital mortality after spine fusion were studied. Furthermore, we analyzed the timing of in-hospital mortality.Results An estimated total of 1,288,496 primary posterior lumbar spine fusion procedures were performed in the US between 1998 and 2008. The average mortality rate for lumbar spine fusion surgery was 0.2 %. Independent risk factors for in-hospital mortality included advanced age, male gender, large hospital size, and emergency admission. Comorbidities associated with the highest in-hospital mortality after lumbar spine fusion surgery were coagulopathy, metastatic cancer, congestive heart failure and renal disease. Most lethal complications were cerebrovascular events, sepsis and pulmonary embolism. Furthermore, we demonstrated that the timing of death occurred relatively early in the in-hospital period with over half of fatalities occurring by postoperative day 9. Conclusion This study provides nationally representative information on risk factors for and timing of perioperative mortality after primary lumbar spine fusion surgery. These data can be used to assess risk for this event and to develop targeted intervention to decrease such risk.

Impact of elective versus emergent admission on perioperative complications and resource utilization in lumbar fusion

“…The incidence of perioperative adverse events has been observed to be higher in the emergent and unplanned cases [11][12][13][14]. A higher rate of perioperative mortality (P < 0.001) and infection-related events (P = 0.02) in the patients admitted on an emergent basis has been reported in the context of spine surgery [4,20]. The aim of this study is to identify the impact of elective versus emergent admissions of patients undergoing lumbar fusions on the trends and patterns of perioperative complications and resource utilization.…”

“…After adjusting the confounding factors including age and comorbidity burden, the type of admission was not associated with a higher incidence of deaths; however, the patients operated on the other days (in the emergent admission group) had higher mortality (Table 4). Pumberger et al [4] reported higher mortality in the patients with emergent admissions, though the influence of other covariates was not controlled to determine an independent role 'type of admission' had on the mortality.…”

“…There is a paucity of literature demonstrating the impact of emergent versus elective admissions for spinal surgery on http://dx.doi.org/10.1016/j.clineuro.2015.05.015 0303-8467/Published by Elsevier B.V. the perioperative outcomes and dynamics of resource utilization. Pumberger et al [4] observed higher mortality in the emergency admission group of lumbar fusion; however, further details of patients' characteristic, comorbidity burden and incidence of perioperative complications within the two groups were not analyzed.…”

“…In spite of being a commonly performed spine surgery, lumbar fusion is not without the risk of complications and death [4]. Influence of several key factors on perioperative morbidity and mortality associated with lumbar fusion has been studied, which include primary diagnosis, comorbidity burden, surgical approach and body habitus [4][5][6][7][8]. Except in certain emergent situations, in the majority of the patients, lumbar fusion is performed as a elective procedure [9].…”

Preoperative Steroid Use and the Risk of Infectious Complications After Neurosurgery

“…On the basis of previously published reports, [25][26][27][28][29][30][31][32][33][34] the following covariates were included a priori as potential confounders in our models: age, sex, race, coronary heart disease, prior stroke or TIA, congestive heart failure, disseminated cancer, hypertension, diabetes mellitus, renal insufficiency, COPD, bleeding disorders, preoperative sepsis, history of wound infection, smoking, and American Society of Anesthesiologists classifications.…”