title: Risk Assessment and Characterization of 30-Day Perioperative Myocardial Infarction Following Spine Surgery: A Retrospective Analysis of 1346 Consecutive Adult Patients.
abstract: METHODS
  A retrospective review.
  
  
  OBJECTIVE
  The aim of the study was to perform a risk assessment of 30-day perioperative myocardial infarction (MI) for spine surgery patients.
  
  
  BACKGROUND
  There is an increased emphasis to reduce complications and improve outcomes after spinal surgery. One of the more devastating perioperative complications of spinal surgery is MI.
  
  
  METHODS
  We evaluated all medical records of 1346 consecutive patients who underwent spinal surgery at a single institution from 2008 to 2010 for incidence of MI within 30 days of surgery and documented all demographic, preoperative, and operative variables. Associations between postoperative MI and individual risk factors were determined using logistic regression analysis. Patients were stratified into emergent and elective groups and a similar analysis was performed.
  
  
  RESULTS
  Overall, 22 patients (1.6%) had 30-day perioperative MI, 14 patients (1.2%) undergoing elective surgery, and 8 patients (4.2%) after emergent surgery (P = 0.047). Three (13.6%) patients experienced 30-day mortality and an additional 3 (13.6%) patients experienced mortality within 1 year. Multivariate logistic regression determined that age more than 65 years, atrial fibrillation, hypertension, prior MI, anticoagulant use, low albumin, length of stay more than 7 days, intraoperative transfusion, trauma etiology, baseline creatinine more than 1  mg/dL, and at least 2 levels of spinal fusion were predictive of postoperative MI. For patients undergoing emergent surgery, age more than 65 years was associated with an increased risk of postoperative MI. When stratified by elective surgery, we found that age more than 65, postoperative stay more than 7 days, intraoperative blood transfusion, baseline creatinine more than 1  mg/dL, and fusion of more than 1 level were associated with an increased risk of MI.
  
  
  CONCLUSIONS
  The present study demonstrates a low incidence of MI after elective surgery with a higher incidence after emergent spine surgery and identifies patient factors predictive of postoperative MI.
  
  
  METHODS
  3.
authors.affiliation: *Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina †Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Timothy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Joel R
authors.initials: JR
authors.lastname: Martin
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Loriaux
authors.forename: Rupen
authors.initials: R
authors.lastname: Desai
authors.forename: Ronnie L
authors.initials: RL
authors.lastname: Shammas
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Jessica
authors.initials: J
authors.lastname: Moreno
authors.forename: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013123:Spinal Fusion / Q000009:adverse effects* / Q000639:trends