title: Improved capture of adverse events after spinal surgery procedures with a longitudinal administrative database.
abstract: OBJECTIVE
  The significant medical and economic tolls of spinal disorders, increasing volume of spine surgeries, and focus on quality metrics have made it imperative to understand postoperative complications. This study demonstrates the utility of a longitudinal administrative database for capturing overall and procedure-specific complication rates after various spine surgery procedures.
  
  
  METHODS
  The Thomson Reuters MarketScan Commercial Claims and Encounters and the Medicare Supplemental and Coordination of Benefits database was used to conduct a retrospective analysis of longitudinal administrative data from a sample of approximately 189,000 patients. Overall and procedure-specific complication rates at 5 time points ranging from immediately postoperatively (index) to 30 days postoperatively were computed.
  
  
  RESULTS
  The results indicated that the frequency of individual complication types increased at different rates. The overall complication rate including all spine surgeries was 13.6% at the index time point and increased to 22.8% at 30 days postoperatively. The frequencies of wound dehiscence, infection, and other wound complications exhibited large increases between 10 and 20 days postoperatively, while complication rates for new chronic pain, delirium, and dysrhythmia increased more gradually over the 30-day period studied. When specific surgical procedures were considered, 30-day complication rates ranged from 8.6% in single-level anterior cervical fusions to 27.3% in multilevel combined anterior and posterior lumbar spine fusions.
  
  
  CONCLUSIONS
  This study demonstrates the usefulness of a longitudinal administrative database in assessing postoperative complication rates after spine surgery. Use of this database gave results that were comparable to those in prospective studies and superior to those obtained with nonlongitudinal administrative databases. Longitudinal administrative data may improve the understanding of overall and procedure-specific complication rates after spine surgery.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Tyler S
authors.initials: TS
authors.lastname: Cole
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Tej D
authors.initials: TD
authors.lastname: Azad
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D016208:Databases, Factual; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013131:Spine / Q000601:surgery*
keywords: CPT = Current Procedural Terminology; ICD-9-CM = International Classification of Disease, Ninth Revision, Clinical Modification; NIS = National (Nationwide) Inpatient Sample; administrative database; longitudinal; outcomes research; postoperative complications; spinal disorders; spine surgery