title: Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program.
abstract: BACKGROUND
  This investigation sought to identify risk factors for immediate postoperative morbidity and mortality among a large series of patients undergoing spine surgery who were prospectively entered into a national registry.
  
  
  METHODS
  The database of the National Surgical Quality Improvement Program was queried to identify all patients undergoing spine surgery in the years 2005 to 2008. Demographic data, comorbidities, medical history, body-mass index, and the type of procedure performed were obtained for all patients. Postoperative complications and mortality within thirty days after the spinal procedure were also documented. The chi-square test and univariate and multivariate logistic regression analyses were used to evaluate the effect of individual risk factors on mortality, as well as the probability of the development of complications.
  
  
  RESULTS
  From 2005 to 2008, 3475 patients undergoing spine surgery were registered in the database. The average age of patients was 55.5 years (range, sixteen to ninety years), and 54% of the cohort were men. Ten patients (0.3%) died after surgery, and there were 407 complications in 263 patients (7.6%). Increased patient age and contaminated or infected wounds were identified as independent predictors of mortality. Increased patient age, cardiac disease, preoperative neurologic abnormalities, prior wound infection, corticosteroid use, history of sepsis, American Society of Anesthesiologists classification of >2, and prolonged operative times were independent predictors for the development of one or more complications.
  
  
  CONCLUSIONS
  Patient age, female sex, longer procedural times, and several types of medical comorbidities influenced the risk of postoperative complications or mortality. This information enhances estimates of morbidity and mortality following spine surgery and may improve patient selection for spine surgery as well as preoperative discussions related to the risks of spine surgery.
authors.affiliation: Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 North Piedras Street, El Paso, TX 79920, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Leah M
authors.initials: LM
authors.lastname: Ochoa
authors.forename: Julia O
authors.initials: JO
authors.lastname: Bader
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Belmont
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013122:Spinal Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult