Jyrki Salmenkivi1, Reijo Sund2, Mika Paavola3, Iiris Ruuth4, Antti Malmivaara5,6. 1. Helsinki University Central Hospital, Consultant surgeon, Orthopedic and Traumatology, Turuntie, Espoo, Finland. 2. Faculty of Social Sciences, Department of Social Research Center for Quantitative Methods, University of Helsinki, Helsinki, Finland. 3. Department of Orthopedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland. 4. National Institute for Health and Welfare (THL), Helsinki, Finland. 5. National Institute for Health and Welfare (THL), the Center for Health and Social Economics, Helsinki, Finland. 6. ORTON Orthopedic Institute of the Invalid Foundation; Helsinki, Finland.
Abstract
STUDY DESIGN: Register study. OBJECTIVE: The purpose of this study was to assess the safety of lumbar spine surgery for degenerative disorders and to assess the predictive factors for mortality and causes of death. SUMMARY OF BACKGROUND DATA: Growing numbers and relative indications of spine surgery emphasize the importance of patient safety. We assessed the incidence of mortality related to surgery, overall case fatality and factors predicting mortality in elective spinal surgery. METHODS: A national database was utilized to assess patient characteristics, surgical procedures, and outcomes of degenerative spinal surgery in Finland. Patients were classified into four diagnostic categories: disc herniation, spinal stenosis, degenerative disc disease, and spondylolysis and spondylolisthesis. The mortality related to surgery and overall mortality in each diagnostic group was analyzed at 7 days, 30 days, 90 days, and 1 year after surgery. We categorized the deaths into medical errors, sequelae of surgery, surgery probably a contributing factor, and deaths not associated with surgery. Age, sex, comorbid conditions, and hospital characteristics were considered as potential risk factors for mortality. RESULTS: Out of 408 deaths (0.67% of total of 61,166 patients) deaths that occurred during the 1-year follow up, 49 deaths (12% of deaths, 0.08% of patients) were classified as having an association with surgery: two deaths by medical errors, 28 deaths by complications after surgery and 19 deaths related to the surgery. The surgery-related 1-year mortality was 0.08%. Age >75 years, male sex, diabetes, and hypertension showed an association with increased risk of death related to surgery. CONCLUSION: Mortality caused by elective spinal surgery is rare. Cardiovascular incidents are the most common reasons for deaths occurring soon after surgery. Consideration of expected gains and risks of surgery, prevention of unintended errors during surgery and recognition and treatment of complications once they occur are recommended. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Register study. OBJECTIVE: The purpose of this study was to assess the safety of lumbar spine surgery for degenerative disorders and to assess the predictive factors for mortality and causes of death. SUMMARY OF BACKGROUND DATA: Growing numbers and relative indications of spine surgery emphasize the importance of patient safety. We assessed the incidence of mortality related to surgery, overall case fatality and factors predicting mortality in elective spinal surgery. METHODS: A national database was utilized to assess patient characteristics, surgical procedures, and outcomes of degenerative spinal surgery in Finland. Patients were classified into four diagnostic categories: disc herniation, spinal stenosis, degenerative disc disease, and spondylolysis and spondylolisthesis. The mortality related to surgery and overall mortality in each diagnostic group was analyzed at 7 days, 30 days, 90 days, and 1 year after surgery. We categorized the deaths into medical errors, sequelae of surgery, surgery probably a contributing factor, and deaths not associated with surgery. Age, sex, comorbid conditions, and hospital characteristics were considered as potential risk factors for mortality. RESULTS: Out of 408 deaths (0.67% of total of 61,166 patients) deaths that occurred during the 1-year follow up, 49 deaths (12% of deaths, 0.08% of patients) were classified as having an association with surgery: two deaths by medical errors, 28 deaths by complications after surgery and 19 deaths related to the surgery. The surgery-related 1-year mortality was 0.08%. Age >75 years, male sex, diabetes, and hypertension showed an association with increased risk of death related to surgery. CONCLUSION: Mortality caused by elective spinal surgery is rare. Cardiovascular incidents are the most common reasons for deaths occurring soon after surgery. Consideration of expected gains and risks of surgery, prevention of unintended errors during surgery and recognition and treatment of complications once they occur are recommended. LEVEL OF EVIDENCE: 3.
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