title: Risk factors for postoperative complication after spinal fusion and instrumentation in degenerative lumbar scoliosis patients.
abstract: BACKGROUND
  Relatively few studies have focused on the major medical complications that are more common in older adults. Furthermore, these studies have generally not reported how accurately a risk factor, or combination of risk factors, can distinguish between those who will have a complication and those who will not.
  
  
  METHODS
  A total of 236 consecutive patients who had undergone surgical treatment for degenerative lumbar scoliosis between June 2008 and June 2012 were included retrospectively in this study. The demographic distribution, medical history, and clinical data were collected to investigate the predictive factors of postoperative complications by logistic regression.
  
  
  RESULTS
  Among 236 eligible patients, major medical complications occurred in 7.2% of cases and wound complications occurred in 1.7% of cases. Ninety-day mortality rate was 0.4%. Postoperative complications were strongly associated with history of severe chronic obstructive pulmonary disease (COPD) (P = 0.031), dyspnea with minimal exertion (P = 0.041), being at least partially dependent (P = 0.041), smoking within the past year (P = 0.044), American Society of Anesthesiologists (ASA) class of more than 2 (P = 0.000), diabetes treated with insulin (P = 0.003), and steroid use for chronic condition (P = 0.003). In logistic regressions, operation time (odds ratio 2.45, 95% confidence interval 1.11-4.78), ASA class (class 3 or 4 vs. class 1 or 2: odds ratio 2.21, 95% confidence interval 1.22-3.45), insulin-dependent diabetes (odds ratio 1.72, 95% confidence interval 1.18-2.43), and steroid use for chronic condition (odds ratio 1.55, 95% confidence interval 1.06-2.32) may be reasonable predictors for an individual's likelihood of surgical complications.
  
  
  CONCLUSIONS
  The occurrence of postoperative complications is most likely multifactorial and is related to operation time, ASA class, insulin-dependent diabetes and steroid use for chronic condition.
authors.forename: Honghui
authors.initials: H
authors.lastname: Tang
authors.forename: Jianfei
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Orthopedics, Huai'an First People's Hospital, Nanjing Medical University, 6 Beijing Road West, Huai'an, Jiangsu 223300, People's Republic of China. habest126@126.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Ji
authors.forename: Shouguo
authors.initials: S
authors.lastname: Wang
authors.forename: Yue
authors.initials: Y
authors.lastname: Xie
authors.forename: Haodong
authors.initials: H
authors.lastname: Fei
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome