Medical Complications After Adult Spinal Deformity Surgery: Incidence, Risk Factors, and Clinical Impact.
METHODS
Retrospective review of a prospective multicenter database evaluating surgical adult spinal deformity (ASD) patients.


OBJECTIVE
This study aims to identify risk factors for medical complications in ASD patients undergoing surgery.


BACKGROUND
ASD surgery is known for its high complication rate. This study examines baseline patient characteristics for predictors of medical complications in surgical ASD patients.


METHODS
Intra and perioperative medical complications were included. Medical complications were: infection, pneumonia, urinary tract infection, c-difficile, sepsis, stroke, delirium, deep venous thrombosis, pulmonary embolism, myocardial infarction, arrhythmia, congestive heart failure, pneumothorax, atelectasis, adult respiratory distress syndrome, bowel obstruction, ileus, and renal failure. Potential predictors were identified using univariate testing. Multivariate Poisson regression was used to determine independent predictors of medical complications. Health-related quality of life (HRQL) was measured using the Oswestry Disability Index and SF-36. Multivariate repeated measures mixed models were used to examine HRQL.


RESULTS
Four hundred forty-eight patients were included. The incidence of patients with at least one medical complication was 26.8%. Potential predictors included: age, BMI, anemia, arthritis, depression, cardiac history, hypertension, lung disease, history of PVD, Charlson Comorbidity Index, ASA, smoking, sex, and the number of years with spine problems. Independent predictors identified on multivariate logistic regression modeling included hypertension (IRR 2.43 P = 0.0001), smoking (IRR 2.49 P = 0.0001), and number of years with spine problems (IRR 1.23 P = 0.03). Despite medical complications, patients experienced significant improvements in HRQL, as measured by the SF-36 (P = 0.0001) and oswestry disability index (P = 0.0001). The rate of improvement and overall improvement compared with baseline were not statistically different than that of patients who did not experience medical complications.


CONCLUSIONS
Risk factors for the development of postoperative medical complications after correction of ASD include smoking, hypertension, and duration of symptoms. Patients who have one or more of these risk factors should be identified and informed during informed consent of their increased risks. They should be optimized preoperatively, and followed closely during the postoperative period.


METHODS
3.
Department of Orthopaedic Surgery, University of Calgary, Calgary, Canada.
Alex
A
Soroceanu
Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS.
Douglas C
DC
Burton
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
Jonathan Haim
JH
Oren
Department of Neurosurgery, University of Virginia, Charlottesville, VA.
Justin S
JS
Smith
Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX.
Richard
R
Hostin
Department of Neurosurgery, University of Virginia, Charlottesville, VA.
Christopher I
CI
Shaffrey
San Diego Center for Spinal Disorders, La Jolla, CA.
Behrooz A
BA
Akbarnia
Department of Neurosurgery, University of California, San Francisco, San Francisco, CA.
Christopher P
CP
Ames
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
Thomas J
TJ
Errico
Rocky Mountain Hospital for Children, Denver, CO.
Shay
S
Bess
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
Munish C
MC
Gupta
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
Vedat
V
Deviren
Spine Service, Hospital for Special Surgery, New York, NY.
Frank J
FJ
Schwab
Spine Service, Hospital for Special Surgery, New York, NY.
Virginie
V
Lafage
D000328:Adult; D000368:Aged; D000013:Congenital Abnormalities / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome