title: Rates and causes of mortality associated with spine surgery based on 108,419 procedures: a review of the Scoliosis Research Society Morbidity and Mortality Database.
abstract: METHODS
  A retrospective review of a prospectively collected database.
  
  
  OBJECTIVE
  To assess rates and causes of mortality associated with spine surgery.
  
  
  BACKGROUND
  Despite the best of care, all surgical procedures have inherent risks of complications, including mortality. Defining these risks is important for patient counseling and quality improvement.
  
  
  METHODS
  The Scoliosis Research Society Morbidity and Mortality database was queried for spinal surgery cases complicated by death from 2004 to 2007, including pediatric (younger than 21 yr) and adult (21 yr or older) patients. Deaths occurring within 60 days and complications within 60 days of surgery that resulted in death were assessed.
  
  
  RESULTS
  A total of 197 mortalities were reported among 108,419 patients (1.8 deaths per 1000 patients). Based on age, rates of death per 1000 patients for adult and pediatric patients were 2.0 and 1.3, respectively. Based on primary diagnosis (available for 107,996 patients), rates of death per 1000 patients were as follows: 0.9 for degenerative (n = 47,393), 1.8 for scoliosis (n = 26,421), 0.9 for spondylolisthesis (n = 11,421), 5.7 for fracture (n = 6706), 4.4 for kyphosis (n = 3600), and 3.3 for other (n = 12,455). The most common causes of mortality included: respiratory/pulmonary causes (n = 83), cardiac causes (n = 41), sepsis (n = 35), stroke (n = 15), and intraoperative blood loss (n = 8). Death occurred prior to hospital discharge for 109 (79%) of 138 deaths for which this information was reported. The specific postoperative day (POD) of death was reported for 94 (48%) patients and included POD 0 (n = 23), POD 1-3 (n = 17), POD 4-14 (n = 30), and POD >14 (n = 24). Increased mortality rates were associated with higher American Society of Anesthesiologists score, spinal fusion, and implants (P < 0.001). Mortality rates increased with age, ranging from 0.9 per 1000 to 34.3 per 1000 for patients aged 20 to 39 years and 90 years or older, respectively.
  
  
  CONCLUSIONS
  This study provides rates and causes of mortality associated with spine surgery for a broad range of diagnoses and includes assessments for adult and pediatric patients. These findings may prove valuable for patient counseling and efforts to improve the safety of patient care.
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA 22908, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Dwight
authors.initials: D
authors.lastname: Saulle
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Chen
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: David W
authors.initials: DW
authors.lastname: Polly
authors.forename: Manish K
authors.initials: MK
authors.lastname: Kasliwal
authors.forename: Paul A
authors.initials: PA
authors.lastname: Broadstone
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D013122:Spinal Diseases / Q000401:mortality / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult