title: The morbidity and mortality of fusions from the thoracic spine to the pelvis in the adult population.
abstract: METHODS
  A retrospective analysis.
  
  
  OBJECTIVE
  To quantify the risks of surgery and explore the associations of early perioperative complications with patient demographics and surgical variables.
  
  
  BACKGROUND
  Long fusions extending from the thoracic spine to the pelvis in adults are increasingly common. Currently, there are few studies detailing the overall risks of such comprehensive reconstructions or how preoperative demographics may be associated with potential complications.
  
  
  METHODS
  A retrospective study was performed at two tertiary referral institutions. Preoperative patient demographics and intraoperative surgical variables were analyzed to explore the potential association with outcomes. The outcomes recorded were death, length of hospital and intensive care unit (ICU) stay, discharge to a rehabilitation facility, major medical complications, neurologic deficits, and the additional unplanned surgeries that patients subsequently underwent.
  
  
  RESULTS
  One hundred three consecutive patients underwent a fusion extending from the thoracic spine to the pelvis for degenerative conditions from 2003 to 2007. There was a 4% mortality rate. The mean hospital stay and mean ICU stay was 12 ± 7 and 2.7 ± 4 days, respectively. Fifty-eight percent of patients were discharged to a rehabilitation facility. Twelve percent of patients experience at least one major medical complication. Seventeen percent of patients had a documented new persistent neurologic deficit that was still present at the final clinic visit. Thirty-five percent of patients underwent at least one unplanned return to the operating theater. There were no perioperative demographics or surgical variables that had a statistically significant association with mortality. Major medical complications were associated with the American Society of Anesthesiologists' (ASA) score (P = 0.030) and the Charlson Comorbidity Index (P = 0.028) but not age (P = 0.273).
  
  
  CONCLUSIONS
  Complex spine reconstruction involving fusions from the thoracic spine to the pelvis continues to be a high-risk procedure in spite of more advanced surgical and perioperative techniques.
authors.affiliation: Department of Orthopaedics, Harborview Medical Center, Seattle, WA, USA. chrishow@u.washington.edu
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Howe
authors.forename: Julie
authors.initials: J
authors.lastname: Agel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lee
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bransford
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Wagner
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D013904:Thoracic Vertebrae / Q000601:surgery*