Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database

OBJECTIVEPostoperative complications are one of the most significant concerns in surgeries of the spine, especially in higher-risk cases such as neuromuscular scoliosis. Neuromuscular scoliosis is a classification of multiple diseases affecting the neuromotor system or musculature of patients leading to severe degrees of spinal deformation, disability, and comorbidity, all likely contributing to higher rates of postoperative complications. The objective of this study was to evaluate deformity correction of patients with neuromuscular scoliosis over a 12-year period (2004–2015) by looking at changes in postsurgical complications and management.METHODSThe authors queried the Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database for neuromuscular scoliosis cases from 2004 to 2015. The SRS M&M database is an international database with thousands of self-reported cases by fellowship-trained surgeons. The database has previously been validated, but reorganization in 2008 created less-robust data sets from 2008 to 2011. Consequently, the majority of analysis in this report was performed using cohorts that bookend the 12-year period (2004–2007 and 2012–2015). Of the 312 individual fields recorded per patient, demographic analysis was completed for age, sex, diagnosis, and preoperative curvature. Analysis of complications included infection, bleeding, mortality, respiratory, neurological deficit, and management practices.RESULTSFrom 2004 to 2015, a total of 29,019 cases of neuromuscular scoliosis were reported with 1385 complications, equating to a 6.3% complication rate when excluding the less-robust data from 2008 to 2011. This study shows a 3.5-fold decrease in overall complication rates from 2004 to 2015. A closer look at complications shows a significant decrease in wound infections (superficial and deep), respiratory complications, and implant-associated complications. The overall complication rate decreased by approximately 10% from 2004–2007 to 2012–2015.CONCLUSIONSThis study demonstrates a substantial decrease in complication rates from 2004 to 2015 for patients with neuromuscular scoliosis undergoing spine surgery. Decreases in specific complications, such as surgical site infection, allow us to gauge our progress while observing how trends in management affect outcomes. Further study is needed to validate this report, but these results are encouraging, helping to reinforce efforts toward continual improvement in patient care.

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Complications following surgery for adolescent idiopathic scoliosis over a 13-year period

The Bone & Joint Journal ◽

10.1302/0301-620x.102b4.bjj-2019-1371.r1 ◽

2020 ◽

Vol 102-B (4) ◽

pp. 519-523

Author(s):

Kenny Y. H. Kwan ◽

Hui Y. Koh ◽

Kathleen M. Blanke ◽

Kenneth M. C. Cheung

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Neurological Deficit ◽

Complication Rate ◽

Perioperative Complications ◽

Research Society ◽

Morbidity And Mortality ◽

Complication Rates ◽

Scoliosis Research Society ◽

Age At Surgery

Aims The purpose of this study was to evaluate the incidence and analyze the trends of surgeon-reported complications following surgery for adolescent idiopathic scoliosis (AIS) over a 13-year period from the Scoliosis Research Society (SRS) Morbidity and Mortality database. Methods All patients with AIS between ten and 18 years of age, entered into the SRS Morbidity and Mortality database between 2004 and 2016, were analyzed. All perioperative complications were evaluated for correlations with associated factors. Complication trends were analyzed by comparing the cohorts between 2004 to 2007 and 2013 to 2016. Results Between 2004 and 2016, a total of 84,320 patients were entered into the database. There were 1,268 patients associated with complications, giving an overall complication rate of 1.5%. Death occurred in 12 patients (0.014%). The three most commonly reported complications were surgical site infection (SSI) (441 patients; 0.52%), new neurological deficit (293; 0.35%), and implant-related complications (172; 0.20%). There was a statistically significant but weak correlation between the occurrence of a SSI and the magnitude of the primary curve ( r = 0.227; p < 0.001), and blood loss in surgery ( r = 0.111; p = 0.038), while the occurrence of a new neurological deficit was correlated statistically significantly but weakly with age at surgery ( r = 0.147; p = 0.004) and magnitude of the primary curve ( r = 0.258; p < 0.001). The overall complication rate decreased from 4.95% during 2004 to 2007 to 0.98% during 2013 to 2016 (p = 0.023). Conclusion An overall complication rate of 1.5% was found in our series after surgery for AIS, with a reduction of complication rates found in the second period of the analysis. Cite this article: Bone Joint J 2020;102-B(4):519–523.

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Instrumentation complication rates following spine surgery: a report from the Scoliosis Research Society (SRS) morbidity and mortality database

Journal of Spine Surgery ◽

10.21037/jss.2018.12.09 ◽

2019 ◽

Vol 5 (1) ◽

pp. 110-115 ◽

Cited By ~ 2

Author(s):

Jamal N. Shillingford ◽

Joseph L. Laratta ◽

Nana O. Sarpong ◽

Rami G. Alrabaa ◽

Meghan K. Cerpa ◽

...

Keyword(s):

Spine Surgery ◽

Research Society ◽

Morbidity And Mortality ◽

Complication Rates ◽

Scoliosis Research Society

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Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery

Journal of Neurosurgery Spine ◽

10.3171/2010.12.spine10486 ◽

2011 ◽

Vol 14 (4) ◽

pp. 470-474 ◽

Cited By ~ 69

Author(s):

Kai-Ming G. Fu ◽

Justin S. Smith ◽

David W. Polly ◽

Christopher P. Ames ◽

Sigurd H. Berven ◽

...

Keyword(s):

Disease Process ◽

Mortality Rates ◽

Research Society ◽

Morbidity And Mortality ◽

Mortality Data ◽

Complication Rates ◽

Physical Status ◽

Scoliosis Research Society ◽

Physical Status Classification ◽

American Society

Object Patients with varied medical comorbidities often present with spinal pathology for which operative intervention is potentially indicated, but few studies have examined risk stratification in determining morbidity and mortality rates associated with the operative treatment of spinal disorders. This study provides an analysis of morbidity and mortality data associated with 22,857 cases reported in the multicenter, multisurgeon Scoliosis Research Society Morbidity and Mortality database stratified by American Society of Anesthesiologists (ASA) physical status classification, a commonly used system to describe preoperative physical status and to predict operative morbidity. Methods The Scoliosis Research Society Morbidity and Mortality database was queried for the year 2007, the year in which ASA data were collected. Inclusion criterion was a reported ASA grade. Cases were categorized by operation type and disease process. Details on the surgical approach and type of instrumentation were recorded. Major perioperative complications and deaths were evaluated. Two large subgroups—patients with adult degenerative lumbar disease and patients with major deformity—were also analyzed separately. Statistical analyses were performed with the chi-square test. Results The population studied comprised 22,857 patients. Spinal disease included degenerative disease (9409 cases), scoliosis (6782 cases), spondylolisthesis (2144 cases), trauma (1314 cases), kyphosis (831 cases), and other (2377 cases). The overall complication rate was 8.4%. Complication rates for ASA Grades 1 through 5 were 5.4%, 9.0%, 14.4%, 20.3%, and 50.0%, respectively (p = 0.001). In patients undergoing surgery for degenerative lumbar diseases and major adult deformity, similarly increasing rates of morbidity were found in higher-grade patients. The mortality rate was also higher in higher-grade patients. The incidence of major complications, including wound infections, hematomas, respiratory problems, and thromboembolic events, was also greater in patients with higher ASA grades. Conclusions Patients with higher ASA grades undergoing spinal surgery had significantly higher rates of morbidity than those with lower ASA grades. Given the common application of the ASA system to surgical patients, this grade may prove helpful for surgical decision making and preoperative counseling with regard to risks of morbidity and mortality.

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Postoperative complications of radical nephrectomy with atrial thrombectomy: A contemporary population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.423 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 423-423 ◽

Cited By ~ 1

Author(s):

Tudor Borza ◽

Benjamin I. Chung ◽

Steven L. Chang

Keyword(s):

Postoperative Complications ◽

Metastatic Disease ◽

Complication Rate ◽

Radical Nephrectomy ◽

Major Complication ◽

Population Based ◽

Morbidity And Mortality ◽

Study Cohort ◽

Complication Rates ◽

Clavien Grade

423 Background: The mainstay treatment for patients with stage T3c renal cell carcinoma is radical nephrectomy with atrial thrombectomy (RN−AT). Although this procedure is widely recognized to have substantial morbidity and mortality, little data exist on the actual rates of postoperative complications. Using a contemporary population−based cohort, we sought to determine the postoperative complication rates among patients undergoing RN−AT. Methods: We queried the Premier Perspective Database (Premier, Inc, Charlotte, NC) to identify patients that underwent nephrectomy (ICD9 55.51) between January 1, 2003 and December 31, 2010. We limited our analysis to patients who concurrently underwent cardiopulmonary bypass, determined through billing codes, as these patients were assumed to have undergone RN−AT. We captured patient and hospital data as well as determined 90−day postoperative complications defined by the Clavien System through review of ICD9 codes and disposition data. Results: Our study cohort included a weighted sample size of 1417 patients; the majority were men (63.7%) and Caucasian (61.9%) with a mean age of 58 years. One−third of patients had metastatic disease while one−quarter had significant comorbidities (i.e., Charlson Comorbidity Score (CCS) ≥2). Ninety−day major complication (Clavien grade 3−5) was present in 38% of patients with half (19%) suffering mortality (Clavien grade 5). The predictors of a major complication included age <50 years (vs >70 years, Odds Ratio [OR] 3.1, p=0.01), CCS ≥3 (vs CCS 0, OR 5.7, p<0.0001), and surgery in an urban hospital (vs rural, OR 8.5, p=0.047). Increased complication rate was not associated with gender, race, metastatic disease, teaching institution, or hospital size. Conclusions: We confirm that RN−AT is associated with significant morbidity and mortality. The mortality rate for this procedure exceeds those reported for other complex surgeries. The higher complication rate seen in younger patients is likely secondary to selection bias. This information is important for preoperative counseling for patients considering RN−AT. Future studies are needed to compare the outcomes of RN−AT versus systemic therapy.

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Postoperative Surgical Site Infection After Spine Surgery: An Update From the Scoliosis Research Society (SRS) Morbidity and Mortality Database*

Spine Deformity ◽

10.1016/j.jspd.2018.04.004 ◽

2018 ◽

Vol 6 (6) ◽

pp. 634-643 ◽

Cited By ~ 7

Author(s):

Jamal N. Shillingford ◽

Joseph L. Laratta ◽

Hemant Reddy ◽

Alex Ha ◽

Ronald A. Lehman ◽

...

Keyword(s):

Surgical Site Infection ◽

Spine Surgery ◽

Research Society ◽

Morbidity And Mortality ◽

Site Infection ◽

Scoliosis Research Society

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Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine191330 ◽

2020 ◽

Vol 33 (3) ◽

pp. 297-306

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Rushikesh S. Joshi ◽

Christopher P. Ames

Keyword(s):

Risk Factor ◽

Complication Rate ◽

Surgical Complications ◽

Deformity Correction ◽

Neurological Deficits ◽

Wedge Osteotomy ◽

Medical Complication ◽

Complication Rates ◽

Cervical Deformity ◽

Significant Difference

OBJECTIVEThe correction of severe cervicothoracic sagittal deformities can be very challenging and can be associated with significant morbidity. Often, soft-tissue releases and osteotomies are warranted to achieve the desired correction. There is a paucity of studies that examine the difference in morbidity and complication profiles for Smith-Petersen osteotomy (SPO) versus 3-column osteotomy (3CO) for cervical deformity correction.METHODSA retrospective comparison of complication profiles between posterior-based SPO (Ames grade 2 SPO) and 3CO (Ames grade 5 opening wedge osteotomy and Ames grade 6 closing wedge osteotomy) was performed by examining a single-surgeon experience from 2011 to 2018. Patients of interest were individuals who had a cervical sagittal vertical axis (cSVA) > 4 cm and/or cervical kyphosis > 20° and who underwent corrective surgery for cervical deformity. Multivariate analysis was utilized.RESULTSA total of 95 patients were included: 49 who underwent 3CO and 46 who underwent SPO. Twelve of the SPO patients underwent an anterior release procedure. The patients’ mean age was 63.2 years, and 60.0% of the patients were female. All preoperative radiographic parameters showed significant correction postoperatively: cSVA (6.2 cm vs 4.5 cm [preoperative vs postoperative values], p < 0.001), cervical lordosis (6.8° [kyphosis] vs −7.5°, p < 0.001), and T1 slope (40.9° and 35.2°, p = 0.026). The overall complication rate was 37.9%, and postoperative neurological deficits were seen in 16.8% of patients. The surgical and medical complication rates were 17.9% and 23.2%, respectively. Overall, complication rates were higher in patients who underwent 3CO compared to those who underwent SPO, but this was not statistically significant (total complication rate 42.9% vs 32.6%, p = 0.304; surgical complication rate 18.4% vs 10.9%, p = 0.303; and new neurological deficit rate 20.4% vs 13.0%, p = 0.338). Medical complication rates were similar between the two groups (22.4% [3CO] vs 23.9% [SPO], p = 0.866). Independent risk factors for surgical complications included male sex (OR 10.88, p = 0.014), cSVA > 8 cm (OR 10.36, p = 0.037), and kyphosis > 20° (OR 9.48, p = 0.005). Combined anterior-posterior surgery was independently associated with higher odds of medical complications (OR 10.30, p = 0.011), and preoperative kyphosis > 20° was an independent risk factor for neurological deficits (OR 2.08, p = 0.011).CONCLUSIONSThere was no significant difference in complication rates between 3CO and SPO for cervicothoracic deformity correction, but absolute surgical and neurological complication rates for 3CO were higher. A preoperative cSVA > 8 cm was a risk factor for surgical complications, and kyphosis > 20° was a risk factor for both surgical and neurological complications. Additional studies are warranted on this topic.

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Postoperative complications in equine elective, clean orthopaedic surgery with/without antibiotic prophylaxis

Tierärztliche Praxis Ausgabe G Großtiere / Nutztiere ◽

10.15653/tpg-170491 ◽

2018 ◽

Vol 46 (02) ◽

pp. 81-86 ◽

Cited By ~ 3

Author(s):

Klaus Failing ◽

Marc Koene ◽

Kerstin Fey ◽

Sabita Stöckle

Keyword(s):

Postoperative Complications ◽

Septic Arthritis ◽

Antibiotic Prophylaxis ◽

Surgical Procedures ◽

Complication Rate ◽

Clinical Relevance ◽

Orthopaedic Surgery ◽

Complication Rates ◽

Perioperative Antibiotics ◽

Type Of Surgery

Summary Objective: Retrospective analysis of postoperative complications in equines after clean, orthopaedic surgical procedures in order to detect differences between animals treated with antibiotics and horses without receiving these drugs. Material and methods: Details on 652 patients, surgical procedures and surgery-associated complications were compiled from horses being operated between June 2011 and January 2015. Antibiotic-receiving patients (n = 259) were tested for differences in complication rates and characteristics to controls (n = 393). Results: The total complication rate was 39.1 %. Increased swelling was observed most often (25.6 %), followed by exudation (7.5 %), fever without incisional alterations (2.3 %), suture dehiscence (1.8 %), and seroma (0.8 %). Seven patients (five treated, two controls) developed septic arthritis within a total of 463 arthroscopies (1.5 %). There were no significant differences in the development of postoperative complications, which were seen in 97/259 (37.5 %) antibiotic receiving patients and in 158/393 (40.2 %) controls. The application of perioperative antibiotics was significantly influenced by surgeon (p < 0.0001) and type of surgery (p = 0.0007) and increased with the number of surgical lesions (p = 0.03). In patients undergoing tendovaginoscopy/ bursoscopy, fasciotomy and neurectomy (n = 98), antibiotic prophylaxis was initiated less frequently than in other surgeries, e. g. combinations of surgeries, splint bone extraction, tenotomy, and arthroscopy (n = 554). Conclusion: Severe complications in equine clean orthopaedic surgery are rare and complication rates in patients either receiving perioperative antibiotics or not were not significantly different. Clinical relevance: Based on the results the use of antibiotics appears to be non-essential in uncomplicated elective orthopaedic interventions in the horse.

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