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Higher ASA grade, blood loss associated with major complications in ASD surgery

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LYON, France — Researchers have determined that ASA grade, duration of surgery and estimated blood loss are perioperative factors associated with a likelihood of major complications from adult spine deformity surgery — information that might help physicians better inform and counsel patients, according to a speaker here.

“Ideally, this predictive model should be able to identify in the future which surgery is more advisable or suitable for each patient according to complication rates and final outcomes,” Ferran Pellisé, MD, of Barcelona, said during his presentation at EuroSpine 2014.

Pellisé and colleagues conducted a retrospective analysis of prospective data collected by the European Spine Study Group for 260 patients operated on for adult spinal deformity (ASD). Pellisé presented the results for the 201 patients stratified into four quartiles based on estimated blood loss as a percent of blood volume.

“An area under the curve was determined to find the discriminatory power of the model,” he said.

The results showed 60 patients with ASD had a total of 99 complications that ranged from minor complications (dural tears) to major (deep infection) complications, which occurred in 18 patients.

Independent variables for these patients included average blood loss of 1.7 L, or about 35% of estimated blood volume, and a mean duration of surgery of 297.7 minutes, according to Pellisé.

“[The results] show the risk of major complication is four-fold in patients with ASA grade 2 if compared with those with ASA grade 1 and seven-fold in ASA grade 3/4 compared with those with ASA grade 1,” Pellisé said.

The area under the curve in the logistic regression model used showed the model had good discriminatory power, he said. — by Susan M. Rapp

Reference:

Pellisé F. Paper #40. Presented at: EuroSpine 2014; Oct. 1-3, 2014; Lyon, France.

Disclosure: The study was partially funded by DePuy Spine.