Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity

International Spine Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates. OBJECTIVE: To assess all-cause mortality following ACSD surgery. METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed. RESULTS: Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80% had at least 1 comorbidity. Surgical approaches included anterior only (15.8%), posterior only (50.0%), and combined anterior/posterior (34.2%). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3% had a 3-column osteotomy. Death was reported for 11 (9.2%) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6% vs 22.0%, P = .006). CONCLUSION: All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2% in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.

Original languageEnglish (US)
Pages (from-to)1277-1285
Number of pages9
JournalNeurosurgery
Volume83
Issue number6
DOIs
StatePublished - Dec 1 2018

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Mortality
Comorbidity
Cause of Death
Narcotics
Obstructive Sleep Apnea
Osteotomy
Counseling
Sepsis
Pneumonia
Decision Making
Therapeutics
Myocardial Infarction
Demography
Databases
Oxygen
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity. / International Spine Study Group.

In: Neurosurgery, Vol. 83, No. 6, 01.12.2018, p. 1277-1285.

Research output: Contribution to journalArticle

International Spine Study Group. / Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity. In: Neurosurgery. 2018 ; Vol. 83, No. 6. pp. 1277-1285.
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title = "Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity",
abstract = "BACKGROUND: Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates. OBJECTIVE: To assess all-cause mortality following ACSD surgery. METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed. RESULTS: Of 123 ACSD patients, 120 (98{\%}) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80{\%} had at least 1 comorbidity. Surgical approaches included anterior only (15.8{\%}), posterior only (50.0{\%}), and combined anterior/posterior (34.2{\%}). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3{\%} had a 3-column osteotomy. Death was reported for 11 (9.2{\%}) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6{\%} vs 22.0{\%}, P = .006). CONCLUSION: All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2{\%} in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.",
author = "{International Spine Study Group} and Smith, {Justin S.} and Shaffrey, {Christopher I.} and Kim, {Han Jo} and Peter Passias and Themistocles Protopsaltis and Renaud Lafage and Mundis, {Gregory M.} and Klineberg, {Eric Otto} and Virginie Lafage and Schwab, {Frank J.} and Scheer, {Justin K.} and Emily Miller and Michael Kelly and Hamilton, {D. Kojo} and Munish Gupta and Vedat Deviren and Richard Hostin and Todd Albert and Riew, {K. Daniel} and Robert Hart and Doug Burton and Shay Bess and Ames, {Christopher P.}",
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T1 - Prospective Multicenter Assessment of All-Cause Mortality Following Surgery for Adult Cervical Deformity

AU - International Spine Study Group

AU - Smith, Justin S.

AU - Shaffrey, Christopher I.

AU - Kim, Han Jo

AU - Passias, Peter

AU - Protopsaltis, Themistocles

AU - Lafage, Renaud

AU - Mundis, Gregory M.

AU - Klineberg, Eric Otto

AU - Lafage, Virginie

AU - Schwab, Frank J.

AU - Scheer, Justin K.

AU - Miller, Emily

AU - Kelly, Michael

AU - Hamilton, D. Kojo

AU - Gupta, Munish

AU - Deviren, Vedat

AU - Hostin, Richard

AU - Albert, Todd

AU - Riew, K. Daniel

AU - Hart, Robert

AU - Burton, Doug

AU - Bess, Shay

AU - Ames, Christopher P.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - BACKGROUND: Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates. OBJECTIVE: To assess all-cause mortality following ACSD surgery. METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed. RESULTS: Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80% had at least 1 comorbidity. Surgical approaches included anterior only (15.8%), posterior only (50.0%), and combined anterior/posterior (34.2%). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3% had a 3-column osteotomy. Death was reported for 11 (9.2%) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6% vs 22.0%, P = .006). CONCLUSION: All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2% in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.

AB - BACKGROUND: Surgical treatments for adult cervical spinal deformity (ACSD) are often complex and have high complication rates. OBJECTIVE: To assess all-cause mortality following ACSD surgery. METHODS: ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Clinical and surgical parameters and all-cause mortality were assessed. RESULTS: Of 123 ACSD patients, 120 (98%) had complete baseline data (mean age, 60.6 yr). The mean number of comorbidities per patient was 1.80, and 80% had at least 1 comorbidity. Surgical approaches included anterior only (15.8%), posterior only (50.0%), and combined anterior/posterior (34.2%). The mean number of vertebral levels fused was 8.0 (standard deviation [SD] = 4.5), and 23.3% had a 3-column osteotomy. Death was reported for 11 (9.2%) patients at a mean of 1.1 yr (SD = 0.76 yr; range = 7 d to 2 yr). Mean follow-up for living patients was 1.2 yr (SD = 0.64 yr). Causes of death included myocardial infarction (n = 2), pneumonia/cardiopulmonary failure (n = 2), sepsis (n = 1), obstructive sleep apnea/narcotics (n = 1), subsequently diagnosed amyotrophic lateral sclerosis (n = 1), burn injury related to home supplemental oxygen (n = 1), and unknown (n = 3). Deceased patients did not significantly differ from alive patients based on demographic, clinical, or surgical parameters assessed, except for a higher major complication rate (excluding mortality; 63.6% vs 22.0%, P = .006). CONCLUSION: All-cause mortality at a mean of 1.2 yr following surgery for ACSD was 9.2% in this prospective multicenter series. Causes of death were reflective of the overall high level of comorbidities. These findings may prove useful for treatment decision making and patient counseling in the context of the substantial impact of ACSD.

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