BACKGROUND: To determine the incidence and risk factors for adverse cardiac events after lumbar spine fusion. METHODS: A total of 50 495 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent lumbar spine fusion between 2005 and 2015. The 30-day postoperative data were analyzed to assess for the incidence of adverse cardiac events including cardiac arrest or myocardial infarction. Of those who experienced an event, patient- and surgery-specific parameters were evaluated to assess for risk factors. RESULTS: A total of 240 cardiac events occurred in the studied cohort (4.76 events/1000 patients). Factors that were associated with an increased cardiac risk were age (odds ratio [OR] = 1.039, 95% confidence interval [CI] = 1.03, 1.05, P < .001), male sex (OR = 1.51, 95% CI = 1.17, 1.94, P = .001), insulin-dependent diabetes (OR = 1.83, 95% CI = 1.29, 2.6, P = .001), American Society of Anesthesiologists (ASA) score >3 (OR = 1.92, 95% CI = 1.00, 3.65, P = .048), absolute hematocrit different from 45 (OR = 1.07, 95% CI = 1.04, 1.10, P < .001), and smoking (OR = 1.39, 95% CI = 1.02, 1.90, P = .04). The impact of sustaining a cardiac event in the setting of single-level lumbar fusion is catastrophic as the 30-day postoperative mortality rate for those sustaining an event was 24.6% (59/240 patients), compared to 0.2% (87/50 255) for those not sustaining an event (P < .001). CONCLUSIONS: Cardiac events after lumbar fusion are a rare but devastating series of complications. Several risk factors were identified, including insulin-dependent diabetes mellitus, smoking, advanced age, male sex, ASA score of >3, and anemia/polycythemia. Considering the severity of these consequences, appropriate risk stratification is imperative, and optimization of modifiable risk factors may mitigate this risk.
BACKGROUND: To determine the incidence and risk factors for adverse cardiac events after lumbar spine fusion. METHODS: A total of 50 495 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent lumbar spine fusion between 2005 and 2015. The 30-day postoperative data were analyzed to assess for the incidence of adverse cardiac events including cardiac arrest or myocardial infarction. Of those who experienced an event, patient- and surgery-specific parameters were evaluated to assess for risk factors. RESULTS: A total of 240 cardiac events occurred in the studied cohort (4.76 events/1000 patients). Factors that were associated with an increased cardiac risk were age (odds ratio [OR] = 1.039, 95% confidence interval [CI] = 1.03, 1.05, P < .001), male sex (OR = 1.51, 95% CI = 1.17, 1.94, P = .001), insulin-dependent diabetes (OR = 1.83, 95% CI = 1.29, 2.6, P = .001), American Society of Anesthesiologists (ASA) score >3 (OR = 1.92, 95% CI = 1.00, 3.65, P = .048), absolute hematocrit different from 45 (OR = 1.07, 95% CI = 1.04, 1.10, P < .001), and smoking (OR = 1.39, 95% CI = 1.02, 1.90, P = .04). The impact of sustaining a cardiac event in the setting of single-level lumbar fusion is catastrophic as the 30-day postoperative mortality rate for those sustaining an event was 24.6% (59/240 patients), compared to 0.2% (87/50 255) for those not sustaining an event (P < .001). CONCLUSIONS: Cardiac events after lumbar fusion are a rare but devastating series of complications. Several risk factors were identified, including insulin-dependent diabetes mellitus, smoking, advanced age, male sex, ASA score of >3, and anemia/polycythemia. Considering the severity of these consequences, appropriate risk stratification is imperative, and optimization of modifiable risk factors may mitigate this risk.
Authors: Daniel D Bohl; Glenn S Russo; Bryce A Basques; Nicholas S Golinvaux; Michael C Fu; William D Long; Jonathan N Grauer Journal: J Bone Joint Surg Am Date: 2014-12-03 Impact factor: 5.284
Authors: Michael J Lee; Mark A Konodi; Amy M Cizik; Richard J Bransford; Carlo Bellabarba; Jens R Chapman Journal: Spine J Date: 2012-01-14 Impact factor: 4.166
Authors: Javier Z Guzman; James C Iatridis; Branko Skovrlj; Holt S Cutler; Andrew C Hecht; Sheeraz A Qureshi; Samuel K Cho Journal: Spine (Phila Pa 1976) Date: 2014-09-01 Impact factor: 3.468
Authors: Jordan A Gruskay; Michael Fu; Bryce A Basques; Daniel D Bohl; Rafael A Buerba; Matthew L Webb; Jonathan N Grauer Journal: Clin Spine Surg Date: 2016-02 Impact factor: 1.876
Authors: Andreea Seicean; Sinziana Seicean; Nima Alan; Nicholas K Schiltz; Benjamin P Rosenbaum; Paul K Jones; Michael W Kattan; Duncan Neuhauser; Robert J Weil Journal: Spine (Phila Pa 1976) Date: 2013-07-01 Impact factor: 3.468
Authors: Wen-Chih Wu; Tracy L Schifftner; William G Henderson; Charles B Eaton; Roy M Poses; Georgette Uttley; Satish C Sharma; Michael Vezeridis; Shukri F Khuri; Peter D Friedmann Journal: JAMA Date: 2007-06-13 Impact factor: 56.272