Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients.
OBJECTIVE
Three-column resection osteotomies (3COs) are commonly performed for sagittal deformity but have high rates of reported complications. Authors of this study aimed to examine the incidence of and intercenter variability in major intraoperative complications (IOCs), major postoperative complications (POCs) up to 6 weeks postsurgery, and overall complications (that is, both IOCs and POCs). They also aimed to investigate the incidence of and intercenter variability in blood loss during 3CO procedures.


METHODS
The incidence of IOCs, POCs, and overall complications associated with 3COs were retrospectively determined for the study population and for each of 8 participating surgical centers. The incidence of major blood loss (MBL) over 4 L and the percentage of total blood volume lost were also determined for the study population and each surgical center. Complication rates and blood loss were compared between patients with one and those with two osteotomies, as well as between patients with one thoracic osteotomy (ThO) and those with one lumbar or sacral osteotomy (LSO). Risk factors for developing complications were determined.


RESULTS
Retrospective review of prospectively acquired data for 423 consecutive patients who had undergone 3CO at 8 surgical centers was performed. The incidence of major IOCs, POCs, and overall complications was 7%, 39%, and 42%, respectively, for the study population overall. The most common IOC was spinal cord deficit (2.6%) and the most common POC was unplanned return to the operating room (19.4%). Patients with two osteotomies had more POCs (56% vs 38%, p = 0.04) than the patients with one osteotomy. Those with ThO had more IOCs (16% vs 6%, p = 0.03), POCs (58% vs 34%, p < 0.01), and overall complications (67% vs 37%, p < 0.01) than the patients with LSO. There was significant variation in the incidence of IOCs, POCs, and overall complications among the 8 sites (p < 0.01). The incidence of MBL was 24% for the study population, which varied significantly between sites (p < 0.01). Patients with MBL had a higher risk of IOCs, POCs, and overall complications (OR 2.15, 1.76, and 2.01, respectively). The average percentage of total blood volume lost was 55% for the study population, which also varied among sites (p < 0.01).


CONCLUSIONS
Given the complexity of 3COs for spinal deformity, it is important for spine surgeons to understand the risk factors and complication rates associated with these procedures. In this study, the overall incidence of major complications following 3CO procedures was 42%. Risks for developing complications included an older age (> 60 years), two osteotomies, ThO, and MBL.
Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;
Kristina
K
Bianco
Robert
R
Norton
Frank
F
Schwab
Justin S
JS
Smith
Eric
E
Klineberg
Ibrahim
I
Obeid
Gregory
G
Mundis
Christopher I
CI
Shaffrey
Khaled
K
Kebaish
Richard
R
Hostin
Robert
R
Hart
Munish C
MC
Gupta
Douglas
D
Burton
Christopher
C
Ames
Oheneba
O
Boachie-Adjei
Themistocles S
TS
Protopsaltis
Virginie
V
Lafage
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods