Medical Complications after Adult Spinal Deformity Surgery: Incidence, Risk factors, and Clinical Impact

Alex Soroceanu, Douglas C. Burton, Jonathan H. Oren, Justin S. Smith, Richard Hostin, Christopher I. Shaffrey, Behrooz A. Akbarnia, Christopher P. Ames, Thomas J. Errico, Shay Bess, Munish C. Gupta, Vedat Deviren, Frank J. Schwab, Virginie Lafage, International Spine Study Group

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

STUDY DESIGN.: Retrospective review of a prospective multi-center database evaluating surgical ASD patients. OBJECTIVE.: This study aims to identify risk factors for medical complications in ASD patients undergoing surgery SUMMARY OF BACKGROUND DATA.: Adult Spinal Deformity (ASD) surgery is known for its high complication rate. This study examines baseline patient characteristics for predictors of medical complications in surgical ASD patients. METHODS.: Intra and perioperative medical complications were included. Medical complications were: infection, pneumonia, UTI, c-difficile, sepsis, stroke, delirium, DVT, PE, MI, arrhythmia, CHF, pneumothorax, atelectasis, ARDS, bowel obstruction, ileus, and renal failure. Potential predictors were identified using univariate testing. Multivariate poisson regression was used to determine independent predictors of medical complications. HRQL were measured using the ODI and SF-36. Multivariate repeated measures mixed models were used to examine HRQL. RESULTS.: 448 patients were included. The incidence of patients with at least one medical complication was 26.8%. Potential predictors included: age, BMI, anemia, arthritis, depression, cardiac history, hypertension, lung disease, history of PVD, Charlson Comorbidity Index, ASA, smoking, gender, and the number of years with spine problems. Independent predictors identified on multivariate logistic regression modeling included hypertension (IRR 2.43 p?=?0.0001), smoking (IRR 2.49 p?=?0.0001) and number of years with spine problems (IRR 1.23 p?=?0.03). Despite medical complications, patients experienced significant improvements in HRQL, as measured by the SF-36 (p?=?0.0001) and ODI (p?=?0.0001). The rate of improvement and overall improvement compared to baseline was not statistically different than that of patients who did not experience medical complications. CONCLUSION.: Risk factors for the development of postoperative medical complications and infections following correction of ASD include smoking, hypertension and duration of symptoms. Patients who have one or more of these risk factors should be identified and informed during informed consent of their increased risks. They should be optimized pre-operatively, and followed closely during the post-operative period.Level of Evidence: 3

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Apr 19 2016

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Incidence
Smoking
Hypertension
Spine
Pulmonary Atelectasis
Delirium
Ileus
Pneumothorax
Infection
Informed Consent
Lung Diseases
Arthritis
Renal Insufficiency
Comorbidity
Cardiac Arrhythmias
Anemia
Sepsis
Pneumonia
Logistic Models
History

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Soroceanu, A., Burton, D. C., Oren, J. H., Smith, J. S., Hostin, R., Shaffrey, C. I., ... International Spine Study Group (Accepted/In press). Medical Complications after Adult Spinal Deformity Surgery: Incidence, Risk factors, and Clinical Impact. Spine. https://doi.org/10.1097/BRS.0000000000001636

Medical Complications after Adult Spinal Deformity Surgery : Incidence, Risk factors, and Clinical Impact. / Soroceanu, Alex; Burton, Douglas C.; Oren, Jonathan H.; Smith, Justin S.; Hostin, Richard; Shaffrey, Christopher I.; Akbarnia, Behrooz A.; Ames, Christopher P.; Errico, Thomas J.; Bess, Shay; Gupta, Munish C.; Deviren, Vedat; Schwab, Frank J.; Lafage, Virginie; International Spine Study Group.

In: Spine, 19.04.2016.

Research output: Contribution to journalArticle

Soroceanu, A, Burton, DC, Oren, JH, Smith, JS, Hostin, R, Shaffrey, CI, Akbarnia, BA, Ames, CP, Errico, TJ, Bess, S, Gupta, MC, Deviren, V, Schwab, FJ, Lafage, V & International Spine Study Group 2016, 'Medical Complications after Adult Spinal Deformity Surgery: Incidence, Risk factors, and Clinical Impact', Spine. https://doi.org/10.1097/BRS.0000000000001636
Soroceanu, Alex ; Burton, Douglas C. ; Oren, Jonathan H. ; Smith, Justin S. ; Hostin, Richard ; Shaffrey, Christopher I. ; Akbarnia, Behrooz A. ; Ames, Christopher P. ; Errico, Thomas J. ; Bess, Shay ; Gupta, Munish C. ; Deviren, Vedat ; Schwab, Frank J. ; Lafage, Virginie ; International Spine Study Group. / Medical Complications after Adult Spinal Deformity Surgery : Incidence, Risk factors, and Clinical Impact. In: Spine. 2016.
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AU - Soroceanu, Alex

AU - Burton, Douglas C.

AU - Oren, Jonathan H.

AU - Smith, Justin S.

AU - Hostin, Richard

AU - Shaffrey, Christopher I.

AU - Akbarnia, Behrooz A.

AU - Ames, Christopher P.

AU - Errico, Thomas J.

AU - Bess, Shay

AU - Gupta, Munish C.

AU - Deviren, Vedat

AU - Schwab, Frank J.

AU - Lafage, Virginie

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N2 - STUDY DESIGN.: Retrospective review of a prospective multi-center database evaluating surgical ASD patients. OBJECTIVE.: This study aims to identify risk factors for medical complications in ASD patients undergoing surgery SUMMARY OF BACKGROUND DATA.: Adult Spinal Deformity (ASD) surgery is known for its high complication rate. This study examines baseline patient characteristics for predictors of medical complications in surgical ASD patients. METHODS.: Intra and perioperative medical complications were included. Medical complications were: infection, pneumonia, UTI, c-difficile, sepsis, stroke, delirium, DVT, PE, MI, arrhythmia, CHF, pneumothorax, atelectasis, ARDS, bowel obstruction, ileus, and renal failure. Potential predictors were identified using univariate testing. Multivariate poisson regression was used to determine independent predictors of medical complications. HRQL were measured using the ODI and SF-36. Multivariate repeated measures mixed models were used to examine HRQL. RESULTS.: 448 patients were included. The incidence of patients with at least one medical complication was 26.8%. Potential predictors included: age, BMI, anemia, arthritis, depression, cardiac history, hypertension, lung disease, history of PVD, Charlson Comorbidity Index, ASA, smoking, gender, and the number of years with spine problems. Independent predictors identified on multivariate logistic regression modeling included hypertension (IRR 2.43 p?=?0.0001), smoking (IRR 2.49 p?=?0.0001) and number of years with spine problems (IRR 1.23 p?=?0.03). Despite medical complications, patients experienced significant improvements in HRQL, as measured by the SF-36 (p?=?0.0001) and ODI (p?=?0.0001). The rate of improvement and overall improvement compared to baseline was not statistically different than that of patients who did not experience medical complications. CONCLUSION.: Risk factors for the development of postoperative medical complications and infections following correction of ASD include smoking, hypertension and duration of symptoms. Patients who have one or more of these risk factors should be identified and informed during informed consent of their increased risks. They should be optimized pre-operatively, and followed closely during the post-operative period.Level of Evidence: 3

AB - STUDY DESIGN.: Retrospective review of a prospective multi-center database evaluating surgical ASD patients. OBJECTIVE.: This study aims to identify risk factors for medical complications in ASD patients undergoing surgery SUMMARY OF BACKGROUND DATA.: Adult Spinal Deformity (ASD) surgery is known for its high complication rate. This study examines baseline patient characteristics for predictors of medical complications in surgical ASD patients. METHODS.: Intra and perioperative medical complications were included. Medical complications were: infection, pneumonia, UTI, c-difficile, sepsis, stroke, delirium, DVT, PE, MI, arrhythmia, CHF, pneumothorax, atelectasis, ARDS, bowel obstruction, ileus, and renal failure. Potential predictors were identified using univariate testing. Multivariate poisson regression was used to determine independent predictors of medical complications. HRQL were measured using the ODI and SF-36. Multivariate repeated measures mixed models were used to examine HRQL. RESULTS.: 448 patients were included. The incidence of patients with at least one medical complication was 26.8%. Potential predictors included: age, BMI, anemia, arthritis, depression, cardiac history, hypertension, lung disease, history of PVD, Charlson Comorbidity Index, ASA, smoking, gender, and the number of years with spine problems. Independent predictors identified on multivariate logistic regression modeling included hypertension (IRR 2.43 p?=?0.0001), smoking (IRR 2.49 p?=?0.0001) and number of years with spine problems (IRR 1.23 p?=?0.03). Despite medical complications, patients experienced significant improvements in HRQL, as measured by the SF-36 (p?=?0.0001) and ODI (p?=?0.0001). The rate of improvement and overall improvement compared to baseline was not statistically different than that of patients who did not experience medical complications. CONCLUSION.: Risk factors for the development of postoperative medical complications and infections following correction of ASD include smoking, hypertension and duration of symptoms. Patients who have one or more of these risk factors should be identified and informed during informed consent of their increased risks. They should be optimized pre-operatively, and followed closely during the post-operative period.Level of Evidence: 3

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