title: Complications related to instrumentation in spine surgery: a prospective analysis.
abstract: OBJECTIVE
  Prospective examination of perioperative complications in spine surgery is limited in the literature. The authors prospectively collected data on patients who underwent spinal fusion at a tertiary care center and evaluated the effect of spinal fusion and comorbidities on perioperative complications.
  
  
  METHODS
  Between May and December 2008 data were collected prospectively in 248 patients admitted to the authors' institution for spine surgery. The 202 patients undergoing spine surgery with instrumentation were further analyzed in this report. Perioperative complications occurring within the initial 30 days after surgery were included. All adverse occurrences, whether directly related to surgery, were included in the analysis.
  
  
  RESULTS
  Overall, 114 (56.4%) of 202 patients experienced at least one perioperative complication. Instrumented fusions were associated with more minor complications (p = 0.001) and more overall complications (0.0024). Furthermore, in the thoracic and lumbar spine, complications increased based on the number of levels fused. Advanced patient age and certain comorbidities such as diabetes, cardiac disease, or a history of malignancy were also associated with an increased incidence of complications.
  
  
  CONCLUSIONS
  Using a prospective methodology with a broad definition of complications, the authors report a significantly higher perioperative incidence of complications than previously indicated after spinal fusion procedures. Given the increased application of instrumentation, especially for degenerative disease, a better estimate of clinically relevant surgical complications could aid spine surgeons and patients in an individualized complication index to facilitate a more thorough risk-benefit analysis prior to surgery.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. peter.campbell@jeffersonhospital.org
authors.forename: Peter G
authors.initials: PG
authors.lastname: Campbell
authors.forename: Sanjay
authors.initials: S
authors.lastname: Yadla
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malone
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation*