title: Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors.
abstract: METHODS
  Analysis of the Nationwide Inpatient Sample (NIS) from 1998 to 2008.
  
  
  OBJECTIVE
  To analyze the most recent available and nationally representative data for risk factors contributing to in-hospital mortality after primary lumbar spine fusion.
  
  
  BACKGROUND
  The total number of lumbar spine fusion surgeries has increased dramatically over the past decades. While the field of spine fusion surgery remains highly dynamic with changes in perioperative care constantly affecting patient care, recent data affecting rates and risk for perioperative mortality remain very limited.
  
  
  METHODS
  We obtained the NIS from the Hospital cost and utilization project. The impact of patient and health care system related demographics, including various comorbidities as well as postoperative complications on the outcome of in-hospital mortality after spine fusion were studied. Furthermore, we analyzed the timing of in-hospital mortality.
  
  
  RESULTS
  An estimated total of 1,288,496 primary posterior lumbar spine fusion procedures were performed in the US between 1998 and 2008. The average mortality rate for lumbar spine fusion surgery was 0.2%. Independent risk factors for in-hospital mortality included advanced age, male gender, large hospital size, and emergency admission. Comorbidities associated with the highest in-hospital mortality after lumbar spine fusion surgery were coagulopathy, metastatic cancer, congestive heart failure and renal disease. Most lethal complications were cerebrovascular events, sepsis and pulmonary embolism. Furthermore, we demonstrated that the timing of death occurred relatively early in the in-hospital period with over half of fatalities occurring by postoperative day 9.
  
  
  CONCLUSIONS
  This study provides nationally representative information on risk factors for and timing of perioperative mortality after primary lumbar spine fusion surgery. These data can be used to assess risk for this event and to develop targeted intervention to decrease such risk.
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA. matthiaspumberger@gmail.com
authors.forename: Matthias
authors.initials: M
authors.lastname: Pumberger
authors.forename: Ya Lin
authors.initials: YL
authors.lastname: Chiu
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
authors.forename: Vassilios
authors.initials: V
authors.lastname: Vougioukas
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013123:Spinal Fusion / Q000401:mortality*; D016896:Treatment Outcome