Model: Patients with trauma to the spine most likely to develop complications

Researchers recently attempted to develop a predictive model for medical complications after spine surgery since complications after spine surgery can play a role in the decision making process for surgeons and patients.

Using prospectively collected data from the Spine End Result Registry (SERR), Michael J. Lee, MD, and colleagues, from Seattle, published the first predictive model for complications related to a patient’s spine surgery.

“A tool such as this is of substantial value in the preoperative counseling of patients, shared surgical decision making, and ultimately improving safety in spine surgery,” Lee and colleagues wrote.

The retrospective analysis they did of the data involved 1,476 patients from the SERR who met the inclusion criteria. The patients were followed for cardiac, pulmonary, urologic and other adverse events (AE) for 2 postoperative years (17.9 months, mean); 731 patients (49.5%) consented to provide detailed questionnaires of their risk factors. Most of the patients were men (57%). The mean age of patients was 49.4 years (range, 18 to 98), and they had a body mass index of 27.7 kg/m².

Lee and colleagues recorded 532 AEs in 23% of patients.

The greatest odds of developing an AE after spine surgery was in patients diagnosed with trauma to the spine and the greatest odds of developing a major complication was also found in the patients with trauma to the spine and those odds were 1.17 times higher than any other medical complications, the researchers noted.

“Trauma patients were 4.12 times more likely to have an adverse event adjusting for those with other spinal diagnoses, the age of the patients, the invasiveness of the surgery, or a history of bleeding disorder or blood clot or CHF [congestive heart failure] (OR, 4.12; 95% CI, 3.02 to 5.61; P<0.0001),” Lee and colleagues wrote.

For predicting any complication, the researchers calculated the area under the receiver operator character code (ROC) to be 0.76, “which is considered a fair discrimination in the ability of the final model to predict adverse events,” they wrote.to be fair by most measures. For predicting a major medical complication, Lee and colleagues calculated the area under the ROC to be 0.81. As such, they estimated in in the study a 65-year-old man undergoing a one-level lumbar laminectomy and posterior lateral instrumented arthrodesis has a 14.6% likelihood of any medical complication and a 3.06% likelihood of a major medical complication.

“The value in this predictive model is first and foremost evident when considering safety in spine surgery. When counseling a patient on whether or not to have surgery, or how much surgery to have, a predictive model such as this is of paramount importance during decision making. However, the complexity of this calculation, may prove to be unwieldy in clinical settings; thus, we have designed a website to facilitate the use of this predictive algorithm, spinesage.com,” Lee and colleagues wrote. – by Robert Linnehan

Disclosure: Lee is a consultant to Stryker Spine for unrelated work and to AOSpine as faculty. He receives endowments paid to his institution from Synthes Spine and fellowship support from AOSpine paid directly to his institution. Full disclosures for investigators can be found at www.thespinejournalonline.com/article/S1529-9430%2813%2901648-3/fulltext.

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Source:

Lee MJ. Spine J. 2014. DOI: 10.1016/j.spinee.2013.10.043