The influence of comorbidity on the risks and benefits of spine surgery for degenerative lumbar disorders.
OBJECTIVE
The ageing of the population will see a growing number of patients presenting for spine surgery with appropriate indications but numerous medical comorbidities. This complicates decision-making, requiring that the likely benefit of surgery (outcome) be carefully weighed up against the potential risk (complications). We assessed the influence of comorbidity on the risks and benefits of spine surgery.


METHODS
3,549/4,053 patients with degenerative lumbar disorders, undergoing surgery with the goal of pain relief, completed the multidimensional Core Outcome Measures Index (COMI; scored 0-10) before and 12 months after surgery. At 12 months postoperatively, they also rated the global treatment outcome and their satisfaction with care. Using the Eurospine Spine Tango Registry, surgeons documented surgical details, American Society of Anesthesiologists comorbidity (ASA) grades and perioperative surgical and general complications.


RESULTS
29.0% patients were rated as ASA1 (normal healthy), 45.7% as ASA2 (mild/moderate systemic disease), 24.9% as ASA3 (severe), and just 0.4% as ASA4 (life-threatening). In going from ASA1 to ASA3 (ASA4 group too small), surgical complications increased significantly from 5.0 to 14.5% and general complications increased from 2.9 to 15.7%; 12-month outcomes showed a corresponding decline, with a good global outcome being reported by 79% ASA1 patients, 76% ASA2, and 68% ASA3. Satisfaction with treatment was 87, 85, and 79%, respectively, and reduction in COMI was 4.2 ± 2.9, 3.7 ± 3.0, and 3.4 ± 3.0 points, respectively. Multiple regression analysis revealed a significant (p < 0.0001) independent effect of ASA grade on both complications and outcome.


CONCLUSIONS
The negative impact of comorbidity on the outcome of spine surgery has not been well investigated/quantified to date. The ASA grade may be helpful in producing algorithms for decision-making and preoperative counselling regarding the corresponding risks and benefits of surgery.
Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland, anne.mannion@yahoo.com.
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Mannion
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Fekete
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Porchet
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Haschtmann
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Jeszenszky
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Kleinstück
D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012042:Registries; D018570:Risk Assessment; D012447:Sacrum / Q000601:surgery*; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome