Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery

Abstract

Objective: This retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery. Methods: Adults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery. Results: A total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p = 0.02) and estimated blood loss over 500 mL (OR, 3.67; p = 0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p = 0.02) and operative time (OR, 1.005; p = 0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p = 0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p = 0.04) and higher intraoperative blood loss (OR, 1.0007; p = 0.03). Conclusion: Preoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery.

Minimally Invasive Surgical Technique through a Natural Anatomical Corridor for C1-C2 Screw Fixation

“…The incidence of surgical site infection in posterior cervical surgery has been reported to be between 3% to 10% [11][12][13][14]. Diabetes has been identified as an independent factor increasing postoperative complications in cervical spine surgery [15].…”

“…The bleeding can be easily controlled with bipolar coagulation and absorbable hemostatic agents. In our microsurgical laboratory, we conducted anatomical dissection studies to identify this corridor and its relationship with the vertebral artery for the screw insertion point as shown in Figure 1B [9][10][11].…”

Benefits of Early Ambulation in Elderly Patients Undergoing Lumbar Decompression and Fusion Surgery: A Prospective Cohort Study

“…Some complications may eventually lead to deadly diseases, such as pulmonary embolism resulting from deep vein thrombosis and sepsis from pressure ulcers. Postoperative ambulation is a significant predictor of patients not developing complications 26 . In the current study, early ambulation showed favorable results, with patients in the EA group having 69.8% lower incidence of urinary retention, and no patients had ileus.…”

Risk Factors for Significant Intraoperative Blood Loss during Anterior Cervical Decompression and Fusion for Degenerative Cervical Diseases

“…14 Significant intraoperative blood loss (SIBL), which was defined as intraoperative blood loss of 500 mL or more, may result in hypotension, hypoxia of tissues and organs, and nerve ischemic injury, thus increasing the recovery time and the morbidity and complication rates. [15][16][17][18] Several surgical and patient factors, such as female sex, low preoperative hemoglobin levels, higher American Society of Anesthesiologists (ASA) classification, longer operative time, lower body mass index (BMI), smoking and older age, may contribute to perioperative blood loss. [19][20][21][22][23][24] SIBL during cervical laminoplasty, especially for OPLL, may result in more neurologic complications, worse neurologic recovery, and longer length of stay.…”