title: Incidence and Risk Factors for Major Surgical Complications in Patients With Complex Spinal Deformity: A Report From an SRS GOP Site.
abstract: Retrospective analysis of a prospectively collected single-center database.
  
  
  
  To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site.
  
  
  
  Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown.
  
  
  
  A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits.
  
  
  
  Major complications were seen in 85 cases, which consisted of neurologic deficits (n = 27; 17 transient and 10 permanent), wound infections (n = 17), implant-related problems (n = 35), progressive deformity (n = 13), and death (n = 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA indicated 3-column osteotomies as an independent risk factor for neurological deficit. Curves 100° and above were at higher risk for complications.
  
  
  
  Postoperative complications were seen in 20% of surgically treated patients with complex spine deformities at a Scoliosis Research Society SRS Global Outreach Program site. Three-column osteotomies were identified as an independent risk factor of both postoperative complications and neurological deficits. The significant observed correlation of 3-column osteotomies and postoperative neurological deficits should serve as a guide for surgeons in the preoperative planning and management of severe spinal deformities, especially in locations with limited resources. Patients undergoing correction of large curves may also have a higher complication rate.
authors.affiliation: Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.affiliation: Department of orthopedic surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yagi
authors.affiliation: Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
authors.forename: Venu M
authors.initials: VM
authors.lastname: Nemani
authors.affiliation: Department of Orthopaedic Surgery, Spine Unit. Hospital Ruber Internacional, Calle de la Maso, 38, 28034 Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sacramento-Dominguez
authors.affiliation: Department of Neurosurgery, Korle bu Teaching Hospital, P.O Box 77 Accra, Ghana.
authors.forename: Harry
authors.initials: H
authors.lastname: Akoto
authors.affiliation: Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cunningham
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis Medical Center, 4860 Y Street, Suite 3800 Sacramento, CA 9581, USA.
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedics, Geisinger Medical Center, 100 N Academy Ave, Danville, PA 17822, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Hess
authors.affiliation: Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, 820 Second Avenue, Suite 7A New York, NY 10017, USA.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: Department of Orthopaedic Surgery, Children's Hospital of Michigan, 3901 Beaubien St, Detroit, MI 48201, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mendelow
authors.affiliation: School of Medicine, University of Athens, Ypsilantou 18 Str., Athens 10676, Greece.
authors.forename: Elias C
authors.initials: EC
authors.lastname: Papadopoulos
authors.affiliation: Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Pedro Rico 31. 8 G, Madrid 28029, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Sanchez-Perez-Grueso
authors.affiliation: Spine Unit, Servicio de COT, Hospital Vall d'Hebron, Balmes, 271 (Sarrià) 08006, Barcelona, Spain.
authors.forename: Feran
authors.initials: F
authors.lastname: Pelise
authors.affiliation: Norwich Orthopedic Group, North Franklin, CT 06254, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Paonesa
authors.affiliation: Research Department, Focos orthopaedic hospital, P.O Box KD 779 kanda, No. 8 Teshie st., Accra, Ghana.
authors.forename: Bettye
authors.initials: B
authors.lastname: Wright
authors.affiliation: Department of Neurosurgery, Korle bu Teaching Hospital, P.O Box 77 Accra, Ghana.
authors.forename: Irene
authors.initials: I
authors.lastname: Wulff
authors.affiliation: Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA. Electronic address: hanjokimmd@gmail.com.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
keywords: Complications; Global outreach site; Kyphosis; Osteotomy; Scoliosis