Risk Factors for Perioperative Cardiac Complications After Lumbar Fusion Surgery

Abstract

Cardiac complication is a leading cause of death in the perioperative period after non-cardiac surgery. The present study retrospectively investigated perioperative cardiac complications after spinal fusion surgery in 901 consecutive adult patients who underwent fusion surgery in the lumbar spine from January 2005 to December 2006. Cardiac complications developed in seven patients (0.8%), four males and three females aged 62 to 75 years (mean 66.6 years), in the perioperative period (myocardial infarction in 6 and angina pectoris in 1). Cardiac complications developed after mini-open transforaminal lumbar interbody fusion in four patients and after anterior lumbar interbody fusion in three. No patient had any symptoms related to cardiac disease before surgery. Common features were age over 60 years, a medical history of hypertension and/or diabetes mellitus, and presence of calcified atherosclerosis of the abdominal aorta and/or common iliac arteries. Five patients improved after conservative medical treatment in an intensive care unit. Percutaneous transluminal coronary angioplasty was performed in one patient and coronary artery bypass graft surgery in one. The possibility of perioperative cardiac complications should be considered before lumbar fusion surgery, especially in elderly patients with hypertension and/or diabetes mellitus, and calcified atherosclerosis of the abdominal aorta and/or common iliac arteries.

Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients

“…For example, while it is intuitive that a larger surgical procedure with greater anesthetic time and blood loss would be associated with greater medical risk to the patient, this finding is inconsistently reported. Some studies have reported that arthrodesis increases medical complications 1,5 as compared to non-fusion surgeries and other studies have suggested there is no correlation 2,7,12 . Similarly, the associations of age and medical co-morbidity to post operative medical complication after spine surgery have been inconsistently reported.…”

“…Similarly, the associations of age and medical co-morbidity to post operative medical complication after spine surgery have been inconsistently reported. 1,2,4,7,11,12 …”

“…Medicare 5 , Workmen’s Compensation, and National Inpatient Sample (NIS) 6,8 administrative data have all been examined to identify risk factors for complication after spine surgery. 1,2,7,12,13 In addition, peri-operative complications have also been analyzed using retrospective chart review data.…”

Risk factors for cardiac complications after spine surgery

“…Though the results of the present study may seem intuitive, the influence of these risk factors has been questioned in the literature 2,7,11…”

“…Cardiac complications are a leading cause of death after non-cardiac surgery 4,5,10. Lee et al reported a 0.8% incidence of cardiac complications after lumbar fusion in retrospective review of 901 patients,11 but identification of statistically significant risk factors was limited by the study methodology.…”