Analysis of Risk Factors for Major Complications Following Elective Posterior Lumbar Fusion.
METHODS
Retrospective study of prospectively collected data.


OBJECTIVE
To identify risk factors for the development of any major complication after elective posterior lumbar fusion (PLF).


BACKGROUND
PLF is one of the most performed fusion techniques with utilization rates increasing by 356% between 1993 and 2001. Surgical and anesthetic advances have made the option of surgery more accessible for elderly patients with a larger comorbidity burden. Identifying risk factors for the development of major complications after elective PLF is important for patient risk stratification and patient safety efforts.


METHODS
The 2011 to 2014 American College of Surgeon's National Surgical Quality Improvement Program database was queried using Current Procedural Terminology codes 22612, 22630, and 22633. Patients were divided into two cohorts based on the development of any major complication. Bivariate and multivariate logistic regression analyses were employed to identify predictors for the development of ≥ 1, ≥ 2, and ≥ 3 major complications.


RESULTS
A total of 7761 patients met the inclusion criteria for the study of which, 2055 (26.5%) patients developed one major complication, 249 (3.2%) patients developed two major complications, and 151 (1.9%) patients developed three major complications. The most common complication was intra/postoperative red blood cell transfusion (23.2%). Three multivariate logistic regression models were employed to identify factors associated with ≥ 1, ≥ 2, and ≥ 3 major complications. Patient variables present across all three models were osteotomy, pelvic fixation, operation time ≥4 hours, bleeding disorder, and American Society of Anesthesiology Class ≥ 3.


CONCLUSIONS
Several risk factors were identified for the development of major complications after elective PLF. Identification of these factors can improve the selection of appropriate surgical candidates, patient risk stratification, and patient postoperative safety.


METHODS
3.
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
John
J
Di Capua
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Sulaiman
S
Somani
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Jun S
JS
Kim
Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.|NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.
Kevin
K
Phan
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Nathan J
NJ
Lee
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Parth
P
Kothari
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Samuel K
SK
Cho
D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*