title: Mortality and morbidity after spinal surgery in patients with Parkinson's disease: a retrospective matched-pair cohort study.
abstract: There is a lack of information about postoperative outcomes and related risk factors associated with spinal surgery in patients with Parkinson's disease (PD).
  
  
  
  This study aimed to investigate the postoperative morbidity and mortality associated with spinal surgery for patients with PD, and the risk factors for poor outcomes.
  
  
  
  This is a retrospective matched-pair cohort study.
  
  
  
  Data of patients who underwent elective spinal surgery between July 2010 and March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan.
  
  
  
  In-hospital mortality and occurrence of postoperative complications.
  
  
  
  For each patient with PD, we randomly selected up to four age- and sex-matched controls in the same hospital in the same year. The differences in in-hospital mortality and occurrence of postoperative complications were compared between patients with PD and controls. A multivariable logistic regression model fitted with a generalized estimation equation was used to identify significant predictors of major complications (surgical site infection, sepsis, pulmonary embolism, respiratory complications, cardiac events, stroke, and renal failure). Multiple imputation was used for missing data.
  
  
  
  Among 154,278 patients undergoing spinal surgery, 1,423 patients with PD and 5,498 matched controls were identified. Crude in-hospital mortality was higher in patients with PD than in controls (0.8% vs. 0.3%, respectively). The crude proportion of major complications was also higher in patients with PD (9.8% vs. 5.1% in controls). Postoperative delirium was more common in patients with PD (30.3%) than in controls (4.3%). Parkinson's disease was a significant predictor of major postoperative complications, even after adjusting for other risk factors (odds ratio, 1.74; 95% confidence intervals, 1.37-2.22; p<.001).
  
  
  
  Patients with PD had a significantly increased risk of postoperative complications following spinal surgery. Postoperative delirium was the most frequently observed complication.
authors.affiliation: Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oichi
authors.affiliation: Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: chikuda-tky@umin.ac.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.affiliation: Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ohya
authors.affiliation: Department of Neurology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Ohtomo
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Morita
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.affiliation: Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010300:Parkinson Disease / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery*
keywords: Delirium; Morbidity; Mortality; National database; Parkinson's disease; Spinal surgery