Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals

OBJECTIVE The goal of this study was to compare inpatient morbidity and mortality after adult spinal deformity (ASD) surgery in teaching versus nonteaching hospitals in the US. METHODS The Nationwide Inpatient Sample was used to identify surgical patients with ASD between 2002 and 2011. Only patients > 21 years old and elective cases were included. Patient characteristics, inpatient morbidity, and inpatient mortality were compared between teaching and nonteaching hospitals. A multivariable logistic regression analysis was performed to examine the effect of hospital teaching status on surgical outcomes. RESULTS A total of 7603 patients were identified, with 61.2% (n = 4650) in the teaching hospital group and 38.8% (n = 2953) in the nonteaching hospital group. The proportion of patients undergoing revision procedures was significantly different between groups (5.2% in teaching hospitals vs 3.9% in nonteaching hospitals, p = 0.008). Likewise, complex procedures (defined as fusion of 8 or more segments and/or osteotomy) were more common in teaching hospitals (27.3% vs 21.7%, p < 0.001). Crude overall complication rates were similar in teaching hospitals (47.9%) compared with nonteaching hospitals (49.8%, p = 0.114). After controlling for patient characteristics, case complexity, and revision status, patients treated at teaching hospitals were significantly less likely to develop a complication when compared with patients treated at a nonteaching hospital (OR 0.89; 95% CI 0.82–0.98). The mortality rate was 0.4% in teaching hospitals and < 0.4% in nonteaching hospitals (p = 0.210). CONCLUSIONS Patients who undergo surgery for ASD at a teaching hospital may have significantly lower odds of complication development compared with patients treated at a nonteaching hospital.

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Predictors of inpatient morbidity and mortality in adult spinal deformity surgery

European Spine Journal ◽

10.1007/s00586-015-4104-x ◽

2015 ◽

Vol 25 (3) ◽

pp. 819-827 ◽

Cited By ~ 42

Author(s):

Nancy Worley ◽

Bryan Marascalchi ◽

Cyrus M. Jalai ◽

Sun Yang ◽

Bassel Diebo ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Morbidity And Mortality ◽

Spinal Deformity Surgery

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P.138 Corrective Adult Spinal Deformity Procedures in a community hospital: a single institution review

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

10.1017/cjn.2016.237 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S52-S52

Author(s):

S Yuh ◽

M Warren ◽

E Frangou ◽

D Warren

Keyword(s):

Spinal Deformity ◽

Community Hospital ◽

De Novo ◽

Adult Spinal Deformity ◽

Tertiary Care ◽

High Volume ◽

Complication Rates ◽

Hardware Failure ◽

Operative Care ◽

Perioperative Complication

Background: Adult spinal deformity (ASD) are typically managed in tertiary care centres due to their complexity in surgical planning and peri-operative care. Methods: A retrospective analysis of consecutive corrective ASD surgery performed by a single surgeon at a community based centre performed between 2012 and 2014. Inclusion criteria were age ≥ 18 years with a minimum of 1 year follow-up. We reviewed age, aetiology, mortality, medical and neurological deficit. All standard radiographic deformity parameters were also evaluated and analysed. Results: n=32 corrective spinal deformity procedures were performed. The most common aetiology was de novo degenerative scoliosis. The mean length of stay was 11.94 days. The most common levels fused from T1-pelvis (n=13). L5/S1 was the most common level requiring interbody fusion (n=17). There were n=10 who required a PSO. Only n=4 patients had EBL greater than 3500cc.There were a total of 9 medical complications with post-operative hypotension being the most common (n=3). Hardware failure across the PSO site was the most common long term complication (n=7). There were n=2 death. There were no reported deep infections requiring revisions. Radiographic parameters analysed showed significant improvement. Conclusions: ASD surgery perioperative complication rates in a community hospital are similar to those done in high volume academic centre.

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Rod-Screw Constructs Composed of Dissimilar Metals Do Not Affect Complication Rates in Posterior Fusion Surgery Performed for Adult Spinal Deformity

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001058 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sahitya K. Denduluri ◽

Jayme C.B. Koltsov ◽

Chason Ziino ◽

Nicole Segovia ◽

Craig McMains ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Posterior Fusion ◽

Dissimilar Metals ◽

Complication Rates ◽

Fusion Surgery

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Differences in Patient Characteristics and Operative Outcomes for 7,059 Adult Spinal Deformity Surgeries Between Neurosurgeons and Orthopedic Surgeons

The Spine Journal ◽

10.1016/j.spinee.2017.07.264 ◽

2017 ◽

Vol 17 (10) ◽

pp. S180

Author(s):

Sulaiman Somani ◽

Rachel Bronheim ◽

Jun Kim ◽

Nathan J. Lee ◽

John Di Capua ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Patient Characteristics ◽

Operative Outcomes ◽

Orthopedic Surgeons

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Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery

Journal of Neurosurgery Spine ◽

10.3171/2015.11.spine151036 ◽

2016 ◽

Vol 25 (1) ◽

pp. 1-14 ◽

Cited By ~ 130

Author(s):

Justin S. Smith ◽

Eric Klineberg ◽

Virginie Lafage ◽

Christopher I. Shaffrey ◽

Frank Schwab ◽

...

Keyword(s):

Patient Care ◽

Spinal Deformity ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Vena Cava ◽

Complication Rates ◽

Inclusion Criteria ◽

Patient Counseling ◽

Delayed Complications

OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82 patients (28.2%). A total of 270 perioperative complications (145 minor; 125 major) were reported, with 152 patients (52.2%) affected, and a total of 199 delayed complications (62 minor; 137 major) were reported, with 124 patients (42.6%) affected. Overall, 469 complications (207 minor; 262 major) were documented, with 203 patients (69.8%) affected. The most common complication categories included implant related, radiographic, neurological, operative, cardiopulmonary, and infection. Higher complication rates were associated with older age (p = 0.009), greater body mass index (p ≤ 0.031), increased comorbidities (p ≤ 0.007), previous spine fusion (p = 0.029), and 3-column osteotomies (p = 0.036). Cases in which 2-year follow-up was not achieved included 2 perioperative mortalities (pulmonary embolus and inferior vena cava injury). CONCLUSIONS This study provides an assessment of complications associated with ASD surgery based on a prospective, multicenter design and with a minimum 2-year follow-up. Although the overall complication rates were high, in interpreting these findings, it is important to recognize that not all complications are equally impactful. This study represents one of the most complete and detailed reports of perioperative and delayed complications associated with ASD surgery to date. These findings may prove useful for treatment planning, patient counseling, benchmarking of complication rates, and efforts to improve the safety and cost-effectiveness of patient care.

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ASA Classification as a Risk Stratification Tool in Adult Spinal Deformity Surgery: A Study of 5805 Patients

Global Spine Journal ◽

10.1177/2192568217700106 ◽

2017 ◽

Vol 7 (8) ◽

pp. 719-726 ◽

Cited By ~ 15

Author(s):

Sulaiman Somani ◽

John Di Capua ◽

Jun S. Kim ◽

Kevin Phan ◽

Nathan J. Lee ◽

...

Keyword(s):

Logistic Regression ◽

Risk Stratification ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Wound Complications ◽

Complication Rates ◽

Multivariate Logistic Regression ◽

Improvement Program ◽

Asa Classification ◽

Increased Risk

Study Design: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery. Methods: The 2010-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision, codes relevant to ASD surgery. Patients were divided based on their ASA classification. Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications for patients with increased ASA scores. Results: A total of 5805 patients met the inclusion criteria, 2718 (46.8%) of which were ASA class I-II and 3087 (53.2%) were ASA class III-IV. Multivariate logistic regression revealed ASA class to be a significant risk factor for mortality (odds ratio [OR] = 21.0), reoperation within 30 days (OR = 1.6), length of stay ≥5 days (OR = 1.7), overall morbidity (OR = 1.4), wound complications (OR = 1.8), pulmonary complications (OR = 2.3), cardiac complications (OR = 3.7), intra-/postoperative red blood cell transfusion (OR = 1.3), postoperative sepsis (OR = 2.7), and urinary tract infection (OR = 1.6). Conclusions: This is the first study evaluating the role of ASA class in ASD surgery with a large patient database. Use of ASA class as a metric for preoperative health was verified and the association of ASA class with postoperative morbidity and mortality in ASD surgery suggests its utility in refining the risk stratification profile and improving preoperative patient counseling for those individuals undergoing ASD surgery.

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Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes

Global Spine Journal ◽

10.1177/2192568220937473 ◽

2020 ◽

Vol 10 (7) ◽

pp. 896-907

Author(s):

Eric O. Klineberg ◽

Peter G. Passias ◽

Gregory W. Poorman ◽

Cyrus M. Jalai ◽

Abiola Atanda ◽

...

Keyword(s):

Postoperative Complications ◽

Postoperative Complication ◽

Spinal Deformity ◽

Surgical Outcomes ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Complication Rates ◽

Estimated Blood Loss ◽

Patient Reported ◽

The Impact

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

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