Scott L Zuckerman1, Nikita Lakomkin2, Justin S Smith3, Christopher I Shaffrey3, Clinton J Devin1,4. 1. Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA. 2. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. 4. Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN, USA.
Abstract
BACKGROUND: Surgery for adult spinal deformity (ASD) can significantly improve quality of life but is associated with significant risk of morbidity. Among the most devastating potential complications after these operations is death. The current study aims to report the incidence, preoperative factors, and postoperative complications associated with all-cause mortality within 1 year following ASD surgery. METHODS: Adults who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Demographic characteristics were extracted. The primary outcome was death within 1 year of ASD surgery. Propensity score matching was used to control for confounding factors, followed by univariate/multivariable logistic regression to predict the odds of death within 1 year of ASD surgery. RESULTS: A total of 6,158 patients underwent ASD surgery and 61 (0.99%) died within one year of surgery. Preoperative factors: controlling for age, gender, American Society of Anesthesiologists (ASA) score and postoperative complications, four independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: increased age (OR =1.03; 95% CI, 1.01-1.06; P=0.012), ASA score (OR =4.32; 95% CI, 2.68-6.94; P<0.001), cancer history (OR =7.91; 95% CI, 4.23-14.78; P<0.001) and unintentional weight loss (OR =4.65; 95% CI, 1.68-12.89; P=0.003). Postoperative complications: using propensity score matching and multivariable logistic regression, three independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: pneumonia (OR =4.00; 95% CI, 1.68-9.53), deep venous thrombosis (DVT) (OR =3.12; 95% CI, 1.20-8.10) and unplanned intubation (OR =3.13; 95% CI, 1.15-8.50). DISCUSSION: Death after elective ASD surgery is a devastating yet uncommon event with an incidence of 1%. Preoperative factors of age, ASA score, cancer history, and unexpected weight loss, along with postoperative complications of pneumonia, DVT, and unplanned intubation were independently associated with all-cause mortality within 1 year of ASD surgery. Interestingly, the potentially more severe complications of sepsis, PE, and MI did not independently predict death.
BACKGROUND: Surgery for adult spinal deformity (ASD) can significantly improve quality of life but is associated with significant risk of morbidity. Among the most devastating potential complications after these operations is death. The current study aims to report the incidence, preoperative factors, and postoperative complications associated with all-cause mortality within 1 year following ASD surgery. METHODS: Adults who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Demographic characteristics were extracted. The primary outcome was death within 1 year of ASD surgery. Propensity score matching was used to control for confounding factors, followed by univariate/multivariable logistic regression to predict the odds of death within 1 year of ASD surgery. RESULTS: A total of 6,158 patients underwent ASD surgery and 61 (0.99%) died within one year of surgery. Preoperative factors: controlling for age, gender, American Society of Anesthesiologists (ASA) score and postoperative complications, four independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: increased age (OR =1.03; 95% CI, 1.01-1.06; P=0.012), ASA score (OR =4.32; 95% CI, 2.68-6.94; P<0.001), cancer history (OR =7.91; 95% CI, 4.23-14.78; P<0.001) and unintentional weight loss (OR =4.65; 95% CI, 1.68-12.89; P=0.003). Postoperative complications: using propensity score matching and multivariable logistic regression, three independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: pneumonia (OR =4.00; 95% CI, 1.68-9.53), deep venous thrombosis (DVT) (OR =3.12; 95% CI, 1.20-8.10) and unplanned intubation (OR =3.13; 95% CI, 1.15-8.50). DISCUSSION: Death after elective ASD surgery is a devastating yet uncommon event with an incidence of 1%. Preoperative factors of age, ASA score, cancer history, and unexpected weight loss, along with postoperative complications of pneumonia, DVT, and unplanned intubation were independently associated with all-cause mortality within 1 year of ASD surgery. Interestingly, the potentially more severe complications of sepsis, PE, and MI did not independently predict death.
Authors: Frank J Schwab; Nicola Hawkinson; Virginie Lafage; Justin S Smith; Robert Hart; Gregory Mundis; Douglas C Burton; Breton Line; Behrooz Akbarnia; Oheneba Boachie-Adjei; Richard Hostin; Christopher I Shaffrey; Vincent Arlet; Kirkham Wood; Munish Gupta; Shay Bess; Praveen V Mummaneni Journal: Eur Spine J Date: 2012-05-17 Impact factor: 3.134
Authors: Rafael De la Garza Ramos; Peter G Passias; Frank Schwab; Ali Bydon; Virginie Lafage; Daniel M Sciubba Journal: Clin Spine Surg Date: 2017-08 Impact factor: 1.876
Authors: Nancy Worley; Bryan Marascalchi; Cyrus M Jalai; Sun Yang; Bassel Diebo; Shaleen Vira; Anthony Boniello; Virginie Lafage; Peter G Passias Journal: Eur Spine J Date: 2015-07-09 Impact factor: 3.134
Authors: Eugene J Carragee; Gilbert Chu; Rajat Rohatgi; Eric L Hurwitz; Bradley K Weiner; S Tim Yoon; Garet Comer; Branko Kopjar Journal: J Bone Joint Surg Am Date: 2013-09-04 Impact factor: 5.284
Authors: Parth Kothari; Nathan J Lee; Dante M Leven; Nikita Lakomkin; John I Shin; Branko Skovrlj; Jeremy Steinberger; Javier Z Guzman; Samuel K Cho Journal: Spine (Phila Pa 1976) Date: 2016-07-15 Impact factor: 3.468
Authors: Justin K Scheer; Justin S Smith; Aaron J Clark; Virginie Lafage; Han Jo Kim; John D Rolston; Robert Eastlack; Robert A Hart; Themistocles S Protopsaltis; Michael P Kelly; Khaled Kebaish; Munish Gupta; Eric Klineberg; Richard Hostin; Christopher I Shaffrey; Frank Schwab; Christopher P Ames Journal: J Neurosurg Spine Date: 2015-02-20
Authors: Justin S Smith; Christopher I Shaffrey; Sigurd Berven; Steven Glassman; Christopher Hamill; William Horton; Stephen Ondra; Frank Schwab; Michael Shainline; Kai-Ming Fu; Keith Bridwell Journal: Neurosurgery Date: 2009-07 Impact factor: 4.654
Authors: Rafael De la Garza-Ramos; Amit Jain; Khaled M Kebaish; Ali Bydon; Peter G Passias; Daniel M Sciubba Journal: J Neurosurg Spine Date: 2016-03-04
Authors: Xiaorong Peng; Chaojin Chen; Jingjing Chen; Yanlin Wang; Duo Yang; Chuzhou Ma; Zifeng Liu; Shaoli Zhou; Ziqing Hei Journal: Front Public Health Date: 2022-09-26