Study identifies risk factors for complications after spine surgery

Spine surgery patients who are older, have a history of sepsis and experience a prolonged operative time are more likely to demonstrate postoperative complications, according to a recently published study.

“Complications following spine surgery may have a substantial impact on the quality of life of patients as well as the outcome of the primary surgical procedure,” study author Andrew J. Schoenfeld, MD, stated in an American Academy of Orthopaedic Surgeons press release. “At the present time, the results of this study may represent some of the best available evidence regarding risk factors for complications and mortality following spine surgery.”

Schoenfeld and his team queried the database of the National Surgical Quality Improvement Program, identifying patients who underwent spine surgery between 2005 and 2008. Data on demographics, medical history, BMI, comorbidities and the procedure performed were obtained. The team also noted any 30-day postoperative complications or mortality.

In all, the team found, 3,475 patients, with an average age of 55.5 years, who underwent spine surgery and were registered in the database in the designated time span. Ten patients (0.3%) were reported to have died following surgery, and 407 complications were identified in 263 patients (7.6%).

Independent predictors of mortality, as noted by the authors, included increased patient age and contaminated or infected wounds. Development of complications was associated with cardiac disease, increased patient age, preoperative neurologic abnormalities, previously reported wound infection, a history of sepsis, corticosteroid use and prolonged operative times.

“Our study only documents complications and mortality that occurred within 30 days after surgery,” Schoenfeld stated in the release. “Many studies exist that illustrated the safety and efficacy of spine surgery, and the intent of this work was not to be alarmist. Our goal was to identify medical conditions and other factors that could be addressed prior to surgery in order to further enhance the safety of spine surgery and help achieve the best results for patients.”

Reference:

Schoenfeld AJ, Ochoa LM, Bader JO, Belmont PJ. Risk factors for immediate postoperative complications and mortality following spine surgery: A study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Joint Surg Am. 2011. doi:10.2106/JBJS.J.01048

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While it may not be surprising that the elderly, those with infected wounds, the neurologically abnormal and those with cardiac disease are at higher risk for postoperative complications, this study is beneficial in pointing out the risk factors and highlighting them. It is useful for us to talk about these risk factors when counseling patients. Equally useful is to factor in these predictors when making decisions of nonoperative versus operative intervention. Driving with your eyes open is always safer than driving with blinders on.

— Todd J Albert, MD
Richard H Rothman Professor and Chairman
Department of Orthopaedic Surgery
Thomas Jefferson University and Hospitals
Philadelphia, PA