Tanvir Johanning Bari1, Sven Karstensen2, Mathias Dahl Sørensen2, Martin Gehrchen2, John Street3, Benny Dahl4. 1. Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. bari.tanvir@gmail.com. 2. Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark. 3. Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Floor 6, Blusson Spinal Cord Center, 818 West 10th Ave., Vancouver, BC, V5Z 1M9, Canada. 4. Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin St, Houston, TX, 77030, USA.
Abstract
STUDY DESIGN: Prospective study. OBJECTIVE: To determine the 2-year risk of revision surgery and all-cause mortality after complex spine surgery, and to assess if prospectively registered adverse events (AE) could predict either outcome. Revision surgery and mortality are serious complications to spine surgery. Previous studies of frequency have mainly been retrospective and few studies have employed competing risk survival analyses. In addition, assessment of predictors has focused on preoperative patient characteristics. The effect of perioperative AEs on revision and all-cause mortality risks are not fully understood. METHODS: Between January 1 and December 31, 2013, we prospectively included all patients undergoing complex spine surgery at a single, tertiary institution. Complex spine surgery was defined as conditions deemed too complicated for surgery at a secondary institute, or patients with severe comorbidities requiring multidisciplinary observation and treatment. AEs were registered using the Spine Adverse Event Severity system and patients were followed for minimum 2 years regarding revision surgery and all-cause mortality. Incidences were estimated using competing risk survival analyses and correlation between AEs and either outcome was assessed using proportional odds models. RESULTS: We included a complete and consecutive cohort of 679 adult and pediatric patients. Demographics, surgical data, AEs, and events of revision or all-cause mortality were registered. The cumulative incidence of 2-year all-cause revision was 19% (16-22%) and all-cause mortality was 15% (12-18%). Deformity surgery was the surgical category with highest incidence of revision and the highest incidence of all-cause mortality was seen in the tumor group. Across surgical categories, cumulative incidences of 2-year revision ranged between 11% (tumor) and 33% (deformity), whilst 2-year all-cause mortality ranged between 3% (deformity) and 33% (tumor). We found that major intraoperative AEs were associated to increased odds of revision. Deep wound infection was associated to increased odds of all-cause mortality. CONCLUSIONS: We report the cumulative incidences of revision surgery and all-cause mortality following complex spine surgery. We found higher incidences of revision compared to previous retrospective studies. Prospectively registered AEs were correlated to increased odds of revision surgery and all-cause mortality. These results may serve as reference for future interventional studies and aid in identifying at-risk patients. LEVEL OF EVIDENCE: I.
STUDY DESIGN: Prospective study. OBJECTIVE: To determine the 2-year risk of revision surgery and all-cause mortality after complex spine surgery, and to assess if prospectively registered adverse events (AE) could predict either outcome. Revision surgery and mortality are serious complications to spine surgery. Previous studies of frequency have mainly been retrospective and few studies have employed competing risk survival analyses. In addition, assessment of predictors has focused on preoperative patient characteristics. The effect of perioperative AEs on revision and all-cause mortality risks are not fully understood. METHODS: Between January 1 and December 31, 2013, we prospectively included all patients undergoing complex spine surgery at a single, tertiary institution. Complex spine surgery was defined as conditions deemed too complicated for surgery at a secondary institute, or patients with severe comorbidities requiring multidisciplinary observation and treatment. AEs were registered using the Spine Adverse Event Severity system and patients were followed for minimum 2 years regarding revision surgery and all-cause mortality. Incidences were estimated using competing risk survival analyses and correlation between AEs and either outcome was assessed using proportional odds models. RESULTS: We included a complete and consecutive cohort of 679 adult and pediatric patients. Demographics, surgical data, AEs, and events of revision or all-cause mortality were registered. The cumulative incidence of 2-year all-cause revision was 19% (16-22%) and all-cause mortality was 15% (12-18%). Deformity surgery was the surgical category with highest incidence of revision and the highest incidence of all-cause mortality was seen in the tumor group. Across surgical categories, cumulative incidences of 2-year revision ranged between 11% (tumor) and 33% (deformity), whilst 2-year all-cause mortality ranged between 3% (deformity) and 33% (tumor). We found that major intraoperative AEs were associated to increased odds of revision. Deep wound infection was associated to increased odds of all-cause mortality. CONCLUSIONS: We report the cumulative incidences of revision surgery and all-cause mortality following complex spine surgery. We found higher incidences of revision compared to previous retrospective studies. Prospectively registered AEs were correlated to increased odds of revision surgery and all-cause mortality. These results may serve as reference for future interventional studies and aid in identifying at-risk patients. LEVEL OF EVIDENCE: I.
Authors: Justin S Smith; Eric Klineberg; Virginie Lafage; Christopher I Shaffrey; Frank Schwab; Renaud Lafage; Richard Hostin; Gregory M Mundis; Thomas J Errico; Han Jo Kim; Themistocles S Protopsaltis; D Kojo Hamilton; Justin K Scheer; Alex Soroceanu; Michael P Kelly; Breton Line; Munish Gupta; Vedat Deviren; Robert Hart; Douglas C Burton; Shay Bess; Christopher P Ames Journal: J Neurosurg Spine Date: 2016-02-26
Authors: Rani Nasser; Sanjay Yadla; Mitchell G Maltenfort; James S Harrop; D Greg Anderson; Alexander R Vaccaro; Ashwini D Sharan; John K Ratliff Journal: J Neurosurg Spine Date: 2010-08
Authors: Rupen Desai; Gautam Nayar; Visakha Suresh; Timothy Y Wang; Daniel Loriaux; Joel R Martin; Oren N Gottfried Journal: J Clin Neurosci Date: 2016-02-28 Impact factor: 1.961
Authors: John T Street; Brian J Lenehan; Christian P DiPaola; Michael D Boyd; Brian K Kwon; Scott J Paquette; Marcel F S Dvorak; Y Raja Rampersaud; Charles G Fisher Journal: Spine J Date: 2011-12-29 Impact factor: 4.166
Authors: Varun Puvanesarajah; Francis H Shen; Jourdan M Cancienne; Wendy M Novicoff; Amit Jain; Adam L Shimer; Hamid Hassanzadeh Journal: J Neurosurg Spine Date: 2016-05-06
Authors: Richard A Deyo; Sohail K Mirza; Brook I Martin; William Kreuter; David C Goodman; Jeffrey G Jarvik Journal: JAMA Date: 2010-04-07 Impact factor: 56.272
Authors: Michael G Fehlings; So Kato; Lawrence G Lenke; Hiroaki Nakashima; Narihito Nagoshi; Christopher I Shaffrey; Kenneth M C Cheung; Leah Carreon; Mark B Dekutoski; Frank J Schwab; Oheneba Boachie-Adjei; Khaled M Kebaish; Christopher P Ames; Yong Qiu; Yukihiro Matsuyama; Benny T Dahl; Hossein Mehdian; Ferran Pellisé-Urquiza; Stephen J Lewis; Sigurd H Berven Journal: Spine J Date: 2018-02-13 Impact factor: 4.166