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High morbidity seen in surgical patients with cauda equina syndrome
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Patients with cauda equina syndrome have a number of severe complications and higher morbidity when they undergo spine surgery compared with patients without this rare condition who undergo surgery, researchers found in their review of cases in a large database.
“Despite the limitations of our analysis, the findings are the first to recognize the association between the severe neurological presentation and consequences inherent to CES [cauda equina syndrome], and the increased overall medical comorbidity related to its development as well as the increased perioperative morbidity, mortality, and duration related to its treatment,” Bryan J. Marascalchi, BS, and colleagues wrote in the study.
The researchers used data collected from the National Inpatient Sample (NIS) database for 2001 to 2010 to identify 11,207 patients with CES who had undergone spine surgery and noted their existing comorbidities, demographics, complications from the procedure, and risk factors associated with mortality and morbidity. They then compared these findings to those of 689,799 patients without CES who underwent a spine procedure, as well. All of the patients underwent some type of spine surgery or related procedure. Lumbar disc displacement non-myelopathic, the most commonly performed surgery, and was done in about 36% of cases, according to the study.
In the findings from Marascalchi and colleagues, patients with CES had a comorbidity rate that was about one-and-one-half times higher than patients without CES. Also, their data showed the CES group had a more than three-times higher mortality rate than the group without CES (0.3% vs 0.08%).
“Along with the significantly increased associated comorbidities on presentation and increased treatment-related complications, the CES cohort was also found to have an increased overall rate of in-hospital morbidity and mortality. Although not a novel finding, pulmonary circulation disorders were found to be associated with additional increased risk for both mortality and morbidity among the CES cohort relative to the unaffected cohort,” the investigators wrote.
The incidence of procedure-related complication in the group with CES was about 18.63% compared with 13.12% for patients without CES, they noted. – by Robert Linnehan
Disclosure: The researchers report no relevant financial disclosures.
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Marascalchi B. Spine. 2014. DOI: 10.1097/BRS.0000000000000170.
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