Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion

Study Design: Retrospective large database study. Objective: To determine the impact of cirrhosis on perioperative outcomes and resource utilization in elective spinal fusion surgery. Methods: Elective spinal fusion hospitalizations in patients with and without cirrhosis were identified using ICD-9-CM codes between the years of 2009 and 2011 using the Nationwide Inpatient Sample database. Main outcome measures were in-hospital neurologic, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, wound-related complications, and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients with and without cirrhosis undergoing spinal fusion. Results: A total of 1 214 694 patients underwent elective spinal fusions from 2009 to 2011. Oh these, 6739 were cirrhotic. Cirrhosis was a significant independent predictor for respiratory (odds ratio [OR] = 1.43, confidence interval [CI] 1.29-1.58; P < .001), gastrointestinal (OR = 1.72, CI 1.48-2.00; P < .001), urinary and renal (OR = 1.90, CI 1.70-2.12; P < 0.001), wound (OR = 1.36, CI 1.17-1.58; P < 0.001), and overall inpatient postoperative complications (OR = 1.43, CI 1.33-1.53; P < .001). Cirrhosis was also independently associated with significantly greater inpatient mortality (OR = 2.32, CI 1.72-3.14; P < .001). Cirrhotic patients also had significantly longer lengths of stay (5.35 vs 3.35 days; P < .001) and inpatient costs ($36 738 vs $29 068; P < .001). Conclusions: Cirrhosis is associated with increased risk of perioperative complications, mortality and greater resource utilization. Cirrhotic patients undergoing spinal fusion surgeries should be counseled on these increased risks. Current strategies for perioperative management of cirrhotic patients undergoing spinal fusion surgery need improvement.

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Patients with abnormal microarchitecture have an increased risk of early complications after spinal fusion surgery

Bone ◽

10.1016/j.bone.2020.115731 ◽

2021 ◽

Vol 143 ◽

pp. 115731

Author(s):

Han Jo Kim ◽

Alexander Dash ◽

Matthew Cunningham ◽

Frank Schwab ◽

James Dowdell ◽

...

Keyword(s):

Spinal Fusion ◽

Early Complications ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Increased Risk

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Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk?

Pediatric Anesthesia ◽

10.1046/j.1460-9592.2003.01171.x ◽

2003 ◽

Vol 13 (9) ◽

pp. 818-822 ◽

Cited By ~ 64

Author(s):

Alice Edler ◽

David J. Murray ◽

Robert B. Forbes

Keyword(s):

Blood Loss ◽

Spinal Fusion ◽

Neuromuscular Disease ◽

Posterior Spinal Fusion ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Increased Risk

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The Efficacy and Perioperative Complications Associated with Lumbar Spinal Fusion Surgery, Focusing on Geriatric Patients in the Republic of Korea

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2013.54.4.323 ◽

2013 ◽

Vol 54 (4) ◽

pp. 323 ◽

Cited By ~ 3

Author(s):

Il-Chun Kim ◽

Jin-Woo Hur ◽

Ki-Young Kwon ◽

Jong-Ju Lee ◽

Jong-Won Lee ◽

...

Keyword(s):

Spinal Fusion ◽

Geriatric Patients ◽

Perioperative Complications ◽

Republic Of Korea ◽

Lumbar Spinal Fusion ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

The Republic ◽

Lumbar Spinal

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Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery

Journal of Neurosurgery Spine ◽

10.3171/2009.10.spine08741 ◽

2010 ◽

Vol 12 (4) ◽

pp. 402-408 ◽

Cited By ~ 36

Author(s):

Jordan M. Cloyd ◽

Frank L. Acosta ◽

Colleen Cloyd ◽

Christopher P. Ames

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Spinal Fusion ◽

Perioperative Complications ◽

Intraoperative Complications ◽

The Elderly ◽

Complication Rates ◽

Fusion Surgery ◽

Spinal Fusion Surgery

Object The elderly compose a substantial proportion of patients presenting with complex spinal pathology. Several recent studies have suggested that fusion of 4 or more levels increases the risk of perioperative complications in elderly patients. Therefore, the purpose of this study was to analyze the effects of age in persons undergoing multilevel (≥ 5 levels) thoracolumbar fusion surgery. Methods A retrospective review of all hospital records, operative reports, and clinic notes was conducted for 124 consecutive patients who underwent surgery between 2000 and 2007 with an average follow-up of 3.5 years and a minimum follow-up of 1.2 years. The most frequent preoperative diagnoses included scoliosis, tumor, osteomyelitis, vertebral fracture, and degenerative disc disease with stenosis. Complications were classified as intraoperative and major and minor postoperative as well as the need for revision surgery. Multivariate logistic regression analysis was used to determine the effects of age and other potentially prognostic factors. Results After controlling for other factors, increasing age was associated with an elevated risk for major postoperative complications (OR 1.04, 95% CI 1.00–1.10) as were increasing levels of fusion (OR 1.5, 95% CI 1.1–2.1) and male sex (OR 4.6, 95% CI 1.3–16.2). In patients 65 years of age or older, rates of intraoperative complications, major and minor postoperative complications, and reoperation were 14.1, 23.4, 29.7, and 26.6%, respectively. The number of comorbidities was associated with a greater risk for perioperative complications in elderly patients (OR 1.8, 95% CI 1.1–2.8). Conclusions Age is a positive risk factor for major postoperative complications in extensive thoracolumbar spinal fusion surgery. Complication rates in the elderly are high, and good clinical judgment and careful patient selection are needed before performing extensive thoracolumbar reconstruction in older persons.

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The impact of obesity measured by outer abdominal fat on instability of the adjacent segments after rigid pedicle screw fixation

Orthopedic Reviews ◽

10.4081/or.2018.7684 ◽

2018 ◽

Vol 10 (2) ◽

Cited By ~ 1

Author(s):

Maximilian Lenz ◽

Carolin Meyer ◽

Christoph Kolja Boese ◽

Jan Siewe ◽

Peer Eysel ◽

...

Keyword(s):

Spinal Fusion ◽

Spinal Surgery ◽

Abdominal Fat ◽

Pedicle Screw Fixation ◽

Adjacent Segment ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lack Of Information ◽

Adjacent Segments ◽

The Impact

Previous studies have shown coherence between obesity and higher rates of complications following spinal surgery. However, there is a lack of information about the influence of obesity and the mass of outer abdominal fat (OAF) on adjacent segment instability after spinal fusion surgery. Radiographs of 194 patients with spinal fusion surgery were assessed retrospectively. Radiographs were performed after surgery during two years’ follow-up and signs of adjacent segment instability were documented. Patients were classified regarding their BMI and extent of OAF was assessed using CT at the umbilical level. In 20 patients (10.3%) instability of adjacent segments occurred during followup. In this cohort mean OAF was significantly thicker (28.07 mm) compared to the patients without instability (22.39) (P=0.038). A total of 45% of patients with instability showed OAF of more than 30 mm at time of intervention compared to 10% in those without signs of instability. There exists significant correlation between the extent of OAF and development of adjacent segment instability postoperatively. Thus, weight reduction before spinal surgery could potentially decrease risk of adjacent segment instability.

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