title: Timing of Complications Occurring Within 30 Days After Adult Spinal Deformity Surgery.
abstract: Cross-sectional study of a national surgical database.
  
  
  
  To investigate the timing of complications after adult spinal deformity (ASD) surgery.
  
  
  
  There is limited data on the range of days when complications after ASD surgery occur.
  
  
  
  The American College of Surgeons National Surgical Quality Improvement database was reviewed for the years 2007-2013. Inclusion criteria were adult patients (over 21 years of age) who underwent spinal fusion for ASD. Ten unique complications occurring within 30 postoperative days were examined and the median day to diagnosis was recorded.
  
  
  
  A total of 1,250 patients met inclusion criteria with an overall complication rate of 13.5%. The median day of diagnosis (and interquartile range) for each complication was as follows: myocardial infarction (3.5, 1-5), pulmonary embolism (4, 2-16), reintubation (4.5, 1-11), pneumonia (6, 3-9), urinary tract infection (11, 5-15), sepsis (12, 6-18.5), deep vein thrombosis (12, 6-19), deep surgical site infection (SSI; 18.5, 13-23), superficial SSI (19, 13-24), and organ space SSI (21, 17-25). The three complications that were most commonly diagnosed before hospital discharge included pneumonia, reintubation, and myocardial infarction (diagnosed before discharge on more than 70% of cases). On the other hand, superficial, deep, and organ space infection were diagnosed in less than 40% of cases before patients left the hospital. On univariate analysis, predictors of complication occurrence included older age (p = .014), instrumentation of 7-12 levels (p = .034), and instrumentation of 13 or more levels (p = .035).
  
  
  
  Understanding the timing of specific complications after adult spinal deformity surgery is important for both patients and clinicians. Efforts in prevention of such conditions should continue, as well as heightened awareness during the periods of highest risk.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Ave, Bronx, NY 10467, USA. Electronic address: rafdelag@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza Ramos
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Division of Spinal Surgery, NYU Medical Center-Hospital for Joint Diseases, 306 East 15th Street, Ground Floor, New York, NY 10003, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Neuman
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Kebaish
authors.affiliation: Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D010351:Patient Discharge; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013997:Time Factors
keywords: Adult spinal deformity; Complications; National Surgical Quality Improvement database; Spinal fusion; Timing