Adverse events in spine surgery in Sweden

Object Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome. Emergency oncological spine surgeries are generally palliative to reduce pain and improve patients' neurology and health-related quality of life. In individuals with limited life expectancy, AEs can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process. The purpose of this study was to determine the true incidence of AEs associated with emergency oncological spine surgery. Methods The authors carried out a prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected on standardized AE forms (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff. Results A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventysix patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases. Conclusions When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population.

Download Full-text

Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2020.01.017 ◽

2020 ◽

Vol 106 (6) ◽

pp. 1167-1173

Author(s):

Henri d’Astorg ◽

Vincent Fière ◽

Maud Dupasquier ◽

Thais Dutra Vieira ◽

Marc Szadkowski

Keyword(s):

Adverse Events ◽

Spine Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Eras Protocol

Download Full-text

Potential opioid-related adverse events following spine surgery in elderly patients

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2019.105550 ◽

2019 ◽

Vol 186 ◽

pp. 105550 ◽

Cited By ~ 1

Author(s):

Mark R. Jones ◽

Ethan Y. Brovman ◽

Matthew B. Novitch ◽

Nikhilesh Rao ◽

Richard D. Urman

Keyword(s):

Adverse Events ◽

Elderly Patients ◽

Spine Surgery ◽

Surgery In Elderly

Download Full-text

Dialysis is an independent risk factor for perioperative adverse events, readmission, reoperation, and mortality for patients undergoing elective spine surgery

The Spine Journal ◽

10.1016/j.spinee.2018.04.007 ◽

2018 ◽

Vol 18 (11) ◽

pp. 2033-2042 ◽

Cited By ~ 7

Author(s):

Taylor D. Ottesen ◽

Ryan P. McLynn ◽

Cheryl K. Zogg ◽

Blake N. Shultz ◽

Nathaniel T. Ondeck ◽

...

Keyword(s):

Risk Factor ◽

Adverse Events ◽

Spine Surgery ◽

Independent Risk Factor

Download Full-text

P.219 The effect of peri-operative adverse events on long-term patient reported outcomes after lumbar spine surgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.330 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S83-S83

Author(s):

O Ayling ◽

C FIsher

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Physical Disability ◽

Research Network ◽

Lumbar Spine Surgery ◽

Degenerative Disorders ◽

Patient Reported ◽

Euroqol 5D

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.

Download Full-text

Quality and Safety Improvement in Spine Surgery

Global Spine Journal ◽

10.1177/2192568219839699 ◽

2020 ◽

Vol 10 (1_suppl) ◽

pp. 17S-28S

Author(s):

Fan Jiang ◽

Jamie R. F. Wilson ◽

Jetan H. Badhiwala ◽

Carlo Santaguida ◽

Michael H. Weber ◽

...

Keyword(s):

Adverse Events ◽

Spine Surgery ◽

Practice Guidelines ◽

Prediction Models ◽

Narrative Review ◽

Quality And Safety ◽

Ovid Medline ◽

Modern Health Care ◽

Safety Improvement ◽

Modern Era

Study Design: Review article. Objectives: A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. Methods: A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. Results: Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. Conclusion: Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.

Download Full-text

Commentary: Ambulation on Postoperative Day #0 Is Associated With Decreased Morbidity and Adverse Events After Elective Lumbar Spine Surgery: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽

10.1093/neuros/nyz519 ◽

2019 ◽

Vol 87 (2) ◽

pp. E113-E114

Author(s):

Sean N Neifert ◽

John M Caridi

Keyword(s):

Lumbar Spine ◽

Adverse Events ◽

Spine Surgery ◽

Lumbar Spine Surgery

Download Full-text

Adverse events and their risk factors 90 days after cervical spine surgery: analysis from the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2018.10.spine18666 ◽

2019 ◽

Vol 30 (5) ◽

pp. 602-614 ◽

Cited By ~ 1

Author(s):

Hesham Mostafa Zakaria ◽

Michael Bazydlo ◽

Lonni Schultz ◽

Markian A. Pahuta ◽

Jason M. Schwalb ◽

...

Keyword(s):

Risk Factors ◽

Cervical Spine ◽

Adverse Events ◽

Urinary Retention ◽

Spine Surgery ◽

Anterior Approach ◽

Private Insurance ◽

Foraminal Stenosis ◽

Cervical Spine Surgery ◽

Discharge Disposition

OBJECTIVEThe Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide, multicenter quality improvement initiative. Using MSSIC data, the authors sought to identify 90-day adverse events and their associated risk factors (RFs) after cervical spine surgery.METHODSA total of 8236 cervical spine surgery cases were analyzed. Multivariable generalized estimating equation regression models were constructed to identify RFs for adverse events; variables tested included age, sex, diabetes mellitus, disc herniation, foraminal stenosis, central stenosis, American Society of Anesthesiologists Physical Classification System (ASA) class > II, myelopathy, private insurance, anterior versus posterior approach, revision procedures, number of surgical levels, length of procedure, blood loss, preoperative ambulation, ambulation day of surgery, length of hospital stay, and discharge disposition.RESULTSNinety days after cervical spine surgery, adverse events identified included radicular findings (11.6%), readmission (7.7%), dysphagia requiring dietary modification (feeding tube or nothing by mouth [NPO]) (6.4%), urinary retention (4.7%), urinary tract infection (2.2%), surgical site hematoma (1.1%), surgical site infection (0.9%), deep vein thrombosis (0.7%), pulmonary embolism (0.5%), neurogenic bowel/bladder (0.4%), myelopathy (0.4%), myocardial infarction (0.4%), wound dehiscence (0.2%), claudication (0.2%), and ileus (0.2%). RFs for dysphagia included anterior approach (p < 0.001), fusion procedures (p = 0.030), multiple-level surgery when considering anterior procedures only (p = 0.037), and surgery duration (p = 0.002). RFs for readmission included ASA class > II (p < 0.001), while preoperative ambulation (p = 0.001) and private insurance (p < 0.001) were protective. RFs for urinary retention included increasing age (p < 0.001) and male sex (p < 0.001), while anterior-approach surgery (p < 0.001), preoperative ambulation (p = 0.001), and ambulation day of surgery (p = 0.001) were protective. Preoperative ambulation (p = 0.010) and anterior approach (p = 0.002) were protective of radicular findings.CONCLUSIONSA multivariate analysis from a large, multicenter, prospective database identified the common adverse events after cervical spine surgery, along with their associated RFs. This information can lead to more informed surgeons and patients. The authors found that early mobilization after cervical spine surgery has the potential to significantly decrease adverse events.

Download Full-text