title: Perioperative complications and adverse events after lumbar spinal surgery: evaluation of 1012 operations at a single center.
abstract: BACKGROUND
  Lumbar surgery and associated complications are increasing as society is aging. However, definitions of complications after lumbar surgery have not been established and previous reports have varied in the definition of, and focus on, intraoperative or major postoperative complications. We analyzed the frequency and severity of perioperative complications and all minor adverse events in lumbar surgery at a single center.
  
  
  METHODS
  We retrospectively reviewed all lumbar surgery, including decompression surgery with or without fusion, at Meijo Hospital over a 10-year period. Perioperative complications and all surgery-related adverse events until 1 month postoperatively were reviewed for 1012 operations on 918 patients (average age 54 years old). The incidence of intraoperative complications was compared between junior (<10 years experience of spine surgery) and senior (≥10 years experience) surgeons.
  
  
  RESULTS
  Perioperative complications and adverse events occurred in 159 operations (15.7%) on 127 patients (13.8%). There were a variety of perioperative adverse events, including digestive problems. Of the 159 complications and events, 24 (2.4%) were intraoperative and 135 (13.3%) were postoperative. Incidence of intraoperative complications was not significantly higher for junior surgeons; however, the operations performed by senior surgeons were significantly more invasive. Complications were more frequent in elderly patients (p < 0.01) and in operations that were longer (p < 0.0001), had greater estimated blood loss (p < 0.0001), and involved use of spinal instrumentation (p < 0.0001). Psychotic symptoms occurred significantly more often in older patients (p < 0.001).
  
  
  CONCLUSIONS
  The absence of a relationship between the experience of the surgeon and incidence of intraoperative complications may be because of the greater effect of invasive surgery. Although age and invasiveness were associated with more perioperative adverse events, we do not conclude that major surgery should be avoided for elderly patients. In contrast, careful focus on the surgical indication and procedure is required for these patients.
authors: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan. imagama@med.nagoya-u.ac.jp
authors: Shiro
authors: S
authors: Imagama
authors: Noriaki
authors: N
authors: Kawakami
authors: Taichi
authors: T
authors: Tsuji
authors: Tetsuya
authors: T
authors: Ohara
authors: Yuji
authors: Y
authors: Matsubara
authors: Tokumi
authors: T
authors: Kanemura
authors: Manabu
authors: M
authors: Goto
authors: Yoshito
authors: Y
authors: Katayama
authors: Naoki
authors: N
authors: Ishiguro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002648:Child; D019299:Decompression, Surgical; D005260:Female; D005276:Fenestration, Labyrinth; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery; D055009:Spondylosis / Q000601:surgery*; D055815:Young Adult