title: Predictors of inpatient morbidity and mortality in adult spinal deformity surgery.
abstract: OBJECTIVE
  This nationwide study identifies ASD surgical risk factors for morbidity/mortality.
  
  
  METHODS
  NIS discharges from 2001 to 2010 aged 25+ with scoliosis diagnoses, 4+ levels fused, and procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included. Demographics, comorbidities and procedure-related complications were determined for each subgroup (degenerative, congenital, idiopathic, other). Multivariate analysis reported as [OR (95% CI)].
  
  
  RESULTS
  11,982 discharges were identified. Morbidity, excluding device-related, and mortality rates were 50.81 and 0.28%, respectively. Certain comorbidities were associated with increased morbidity/mortality: congestive heart failure (CHF) [1.62 (1.42-1.84)] [5.67 (3.30-9.73)], coagulopathy [3.52 (3.22-3.85)] [2.32 (1.44-3.76)], electrolyte imbalance [2.65 (2.52-2.79)] [4.63 (3.15-6.81)], pulmonary circulation disorders [9.45 (7.45-11.99)] [8.94 (4.43-18.03)], renal failure [1.29 (1.13-1.47)] [5.51 (2.57-11.82)], and pathologic weight loss [2.38 (2.01-2.81)] [7.28 (4.36-12.14)]. Chronic pulmonary disease was associated with higher morbidity [1.08 (1.02-1.14)]; liver disease was linked to increased mortality [36.09 (16.16-80.59)]. 9+ level fusions had increased morbidity vs 4-8 level fusions [1.69 (1.61-1.78)] and refusions [1.08 (1.02-1.14)]. Idiopathic scoliosis was associated with decreased morbidity vs all other subgroups [0.85 (0.80-0.91)]. Age >65 was associated with increased morbidity and mortality vs 25-64 group [1.09 (1.05-1.14)] [3.49 (2.31-5.29)]. Females had increased morbidity [1.18 (1.13-1.23)] and decreased mortality [0.30 (0.21-0.44)]. Mean comorbidity index (0.55) and age (64.38) for degenerative cohort were higher vs all other subgroups (P < 0.0001).
  
  
  CONCLUSIONS
  Longer fusions were associated with increased morbidity. Age >65 was associated with increased morbidity/mortality, while females were associated with increased morbidity but decreased mortality. Idiopathic scoliosis had decreased morbidity. Degenerative ASD cases had higher comorbidity indices, potentially due to older age. This study is clinically useful for patient education, surgical decision-making, and optimizing patient outcomes.
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Worley
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Marascalchi
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Cyrus M
authors.initials: CM
authors.lastname: Jalai
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Sun
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Bassel
authors.initials: B
authors.lastname: Diebo
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Shaleen
authors.initials: S
authors.lastname: Vira
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Boniello
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: NY Spine Institute/NYU Medical Center-Hospital for Joint Diseases, 301 E. 17th Street, New York, NY, 10003, USA. pgpassias@yahoo.com.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D012737:Sex Factors; D013123:Spinal Fusion; D014481:United States / Q000453:epidemiology
keywords: Adult spinal deformity; Complications; Morbidity; Mortality; Outcomes