Junichi Ohya1, Hirotaka Chikuda2, So Kato2, Hiromasa Horiguchi3, Katsushi Takeshita2, Sakae Tanaka2, Hideo Yasunaga3. 1. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: oyaj-ort@h.u-tokyo.ac.jp. 2. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. 3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Abstract
OBJECTIVE: To examine in-hospital mortality and postoperative major complications in patients undergoing fusion surgery for atlantoaxial subluxation (AAS) and to examine whether the risk of perioperative complications varies between patients with and without rheumatoid arthritis (RA). METHODS: A retrospective analysis of data from the Diagnosis Procedure Combination database, a nationwide administrative impatient database in Japan, identified 1090 patients who underwent spinal fusion surgery for AAS during 2007-2012. Patients' clinical characteristics were extracted, including age, sex, use of homologous blood transfusion, length of stay, and type of hospital. Clinical outcomes included in-hospital death and major complications, including surgical-site infection, sepsis, cardiac events, respiratory disorders, acute renal failure, pulmonary embolism, perioperative stroke, and vertebral injury. Massive blood transfusion was defined as at least 6 units of red blood cells. RESULTS: Four hundred sixty-five patients (42.7%) were classified as the RA group. In-hospital mortality after fusion surgery for AAS was 0.5% (5/1090), and major complications occurred in 5% (55/1090). Multivariate analyses showed that patients with RA were more likely to have major complications after surgery than patients without RA (odds ratio: 1.69; 95% confidence interval: 0.96-2.97; P = 0.07), and the rate of massive blood transfusion was significantly greater in patients with RA than in patients without RA (odds ratio: 2.29; 95% confidence interval: 1.12-4.68; P = 0.02). CONCLUSIONS: The in-hospital mortality after fusion surgery for AAS was relatively low. However, patients with RA had an increased risk of postoperative complications and massive blood transfusion compared with patients without RA.
OBJECTIVE: To examine in-hospital mortality and postoperative major complications in patients undergoing fusion surgery for atlantoaxial subluxation (AAS) and to examine whether the risk of perioperative complications varies between patients with and without rheumatoid arthritis (RA). METHODS: A retrospective analysis of data from the Diagnosis Procedure Combination database, a nationwide administrative impatient database in Japan, identified 1090 patients who underwent spinal fusion surgery for AAS during 2007-2012. Patients' clinical characteristics were extracted, including age, sex, use of homologous blood transfusion, length of stay, and type of hospital. Clinical outcomes included in-hospital death and major complications, including surgical-site infection, sepsis, cardiac events, respiratory disorders, acute renal failure, pulmonary embolism, perioperative stroke, and vertebral injury. Massive blood transfusion was defined as at least 6 units of red blood cells. RESULTS: Four hundred sixty-five patients (42.7%) were classified as the RA group. In-hospital mortality after fusion surgery for AAS was 0.5% (5/1090), and major complications occurred in 5% (55/1090). Multivariate analyses showed that patients with RA were more likely to have major complications after surgery than patients without RA (odds ratio: 1.69; 95% confidence interval: 0.96-2.97; P = 0.07), and the rate of massive blood transfusion was significantly greater in patients with RA than in patients without RA (odds ratio: 2.29; 95% confidence interval: 1.12-4.68; P = 0.02). CONCLUSIONS: The in-hospital mortality after fusion surgery for AAS was relatively low. However, patients with RA had an increased risk of postoperative complications and massive blood transfusion compared with patients without RA.
Authors: Joseph E Tanenbaum; Daniel Lubelski; Benjamin P Rosenbaum; Nicolas R Thompson; Edward C Benzel; Thomas E Mroz Journal: Spine J Date: 2016-01-11 Impact factor: 4.166
Authors: Benjamin D Streufert; Chiduziem Onyedimma; Yagiz U Yolcu; Abdul Karim Ghaith; Benjamin D Elder; Ahmad Nassr; Bradford Currier; Arjun S Sebastian; Mohamad Bydon Journal: Global Spine J Date: 2022-03-18