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Complications and Readmission after Lumbar Spine Surgery in Elderly Patients: An Analysis of 2320 Patients
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S113–S250
44.8% and 31.8% at 90 days and one year, respectively. Wound infection was the reason for readmission in 25.8% of all readmissions within 30 days. Diagnoses of chronic pulmonary disease (OR 1.41 95% CI 1.22–1.63), obesity (OR 2.20 95% CI 1.90–2.54), and positive smoking history (OR 1.33 95% CI 1.15–1.54) were associated with increased risk of surgical readmission. CONCLUSIONS: Elderly patients treated with primary elective 1–2 level lumbar spine fusion for degenerative pathology experience 30-day, 90day, and 1-year readmission rates of 2.9, 5.3, and 12.5% following surgery. Wound complications represent over a quarter of all readmissions within thirty days. Obesity, smoking history, and chronic pulmonary disease are significant risk factors for surgical readmission within thirty days. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.208
183. Complications and Readmission after Lumbar Spine Surgery in Elderly Patients: An Analysis of 2320 Patients Ahmed Saleh, MD1, Addisu Mesfin, MD1, Caroline Thirukumaran, MBBS, MHA2, Robert W. Molinari, MD1; 1 University of Rochester, Rochester, NY, USA; 2Rochester, NY, USA BACKGROUND CONTEXT: There is a paucity of literature describing risk factors for adverse outcomes after geriatric lumbar spinal surgery. How safe is lumbar surgery in elderly patients? Does patient selection, type of surgery, length of surgery, and other elderly patient comorbidities affect complication and readmission rates after surgery? PURPOSE: Identify risk factors for adverse outcomes after geriatric lumbar spinal surgery. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients over 80 years old who underwent lumbar spinal surgery in the ACS-NSQIP Database from 2005–2013. OUTCOME MEASURES: Outcome measures studied were major complications, minor complications, readmissions, and mortality. METHODS: A retrospective cohort study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients over the age of 80 who underwent lumbar spinal surgery from 2005–2013 were identified using ICD-9 diagnosis codes and CPT codes. Outcome data were classified as either a major complication, minor complication, readmission, or mortality. Major complications included sepsis, pulmonary embolism, deep surgical site infection, organ or surgical site infection, unplanned intubation, CVA, MI, cardiac arrest, ventilator use >48 hours, septic shock, acute renal failure, peripheral nerve injury, coma, or graft/prosthesis/flap failure. Minor complications included blood transfusion, UTI, DVT, superficial SSI, pneumonia, renal insufficiency, and wound dehiscence. Multivariate logistic regression models were used to determine factors which placed the patients at risk to develop adverse outcomes in the initial 30 postoperative days. RESULTS: A total of 2,320 patients over the age of 80 who underwent lumbar spine surgery were identified. Overall, 379 (16.34%) patients experienced at least one complication or death. 75 (3.23%) patients experienced a major complication. 338 (14.57%) patients experienced a minor complication. 86 (6.39%) patients were readmitted to the hospital within 30 days. 10 (0.43%) deaths recorded in the initial 30 postoperative days. Increased operative times were strongly associated with perioperative complications (operative time >180 mins, OR: 3.07 [2.23–4.22] and operative time 120–180 mins, OR: 1.77 [1.27–2.47]. Instrumentation and/or fusion procedures were also associated with increased risk of developing a complication (OR: 2.56 [1.66– 3.94]). Readmission was strongly associated with patients who were considered underweight (BMI <18.5) and who were functionally debilitated at the time of admission (OR: 4.10 [1.08–15.48], OR: 2.79 [1.40–5.56] respectively). CONCLUSIONS: Elderly patients undergoing lumbar spinal surgery have high complications and readmission rates. Risk factors for complications include longer operative time, and more extensive procedures involving instrumentation and fusion. Higher readmission rates are associated with low
baseline patient functional status and low patient BMI Surgeons should remain cognizant of these risk factors and exercise caution when planning lumbar surgery in very elderly patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.209
184. Frailty Index is a Significant Predictor of Complications and Readmissions following Posterior Lumbar Fusion Nathan J. Lee, BS1, Parth Kothari, BS1, Dante M. Leven, DO, PT1, Jeremy Steinberger, MD2, Javier Guzman, MD2, Branko Skovrlj, MD3, Samuel K. Cho, MD4; 1Mount Sinai School of Medicine, New York, NY, USA; 2New York, NY, USA; 3Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, USA; 4Icahn School of Medicine at Mount Sinai, New York, NY, USA BACKGROUND CONTEXT: Frailty index is a measure of health status in aging individuals and is an important factor that can be used to predict morbidity and mortality. The Modified Frailty Index (mFI) has been studied outside of the spine patient population and has been shown to be useful in predicting complications and outcomes. The mFI has not been studied in patients undergoing elective posterior lumbar fusions. PURPOSE: Our objective was to analyze the mFI as potential predictive model for complications, reoperations and readmissions within 30 days following lumbar fusion. STUDY DESIGN/SETTING: Retrospective analysis of prospectively collected data. The mFI was calculated based on the number of positive comorbidities present out of 11 total (described elsewhere by Adams et al). PATIENT SAMPLE: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. All patients >18 years old undergoing elective posterior lumbar fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or PLF with PLIF or TLIF registered in the database. OUTCOME MEASURES: Readmissions, complications, mortality, perioperative events and reoperations within 30 days. METHODS: This was a retrospective analysis of prospectively collected data from the ACS NSQIP database of patients >18 years old undergoing elective PLF, PLIF, TLIF or PLF with PLIF or TLIF between 2005 and 2012. A previously described mFI was calculated based on number of positive factors out of 11 (based on medical comorbidities). Complications, operative factors, patient factors and mortality were analyzed using univariate and multivariate logistic regression analysis with significance defined as p<.05. Odds ratio (OR) was calculated with a 95% confidence interval. RESULTS: There were 6,094 patients met inclusion criteria. Mean mFI was 0.087 (0–0.54). Increasing mFI score was associated with increased complications, reoperations, prolonged length of stay (LOS), and morbidity (p<.05). As the mFI score increased from 0.27 (3/11 variables present) to ≥0.36 (4/ 11) the rate of any complication increased from 26.8% to 35% (p<.0001), sepsis 2.4% to 5.2% (p<.0001), wound complications 4.4% to 6.5% (p<.0001), unplanned readmissions 4.7% to 20% (p=.02) and urinary tract infection (UTI) 4.1% to 10.4% (p<.0001). An mFI of >/= to 0.36 was an independent predictor of any complication (OR 2.2,1.3–3.7), sepsis (OR 6.3,1.8–21), wound complications (OR 2.9,1.1–8.2), prolonged LOS (OR 2.3,1.4–3.7) and readmission (OR 4.3,1.5–12.7). CONCLUSIONS: Patients with higher mFI scores (≥4/11 variables) are at significantly increased risk of major complications, readmissions and prolonged LOS following elective posterior lumbar fusion. These findings highlight the importance of sound preoperative work-up during surgical planning and this predictive model may be a useful tool during risk stratification. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.210
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S113–S250
44.8% and 31.8% at 90 days and one year, respectively. Wound infection was the reason for readmission in 25.8% of all readmissions within 30 days. Diagnoses of chronic pulmonary disease (OR 1.41 95% CI 1.22–1.63), obesity (OR 2.20 95% CI 1.90–2.54), and positive smoking history (OR 1.33 95% CI 1.15–1.54) were associated with increased risk of surgical readmission. CONCLUSIONS: Elderly patients treated with primary elective 1–2 level lumbar spine fusion for degenerative pathology experience 30-day, 90day, and 1-year readmission rates of 2.9, 5.3, and 12.5% following surgery. Wound complications represent over a quarter of all readmissions within thirty days. Obesity, smoking history, and chronic pulmonary disease are significant risk factors for surgical readmission within thirty days. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.208
183. Complications and Readmission after Lumbar Spine Surgery in Elderly Patients: An Analysis of 2320 Patients Ahmed Saleh, MD1, Addisu Mesfin, MD1, Caroline Thirukumaran, MBBS, MHA2, Robert W. Molinari, MD1; 1 University of Rochester, Rochester, NY, USA; 2Rochester, NY, USA BACKGROUND CONTEXT: There is a paucity of literature describing risk factors for adverse outcomes after geriatric lumbar spinal surgery. How safe is lumbar surgery in elderly patients? Does patient selection, type of surgery, length of surgery, and other elderly patient comorbidities affect complication and readmission rates after surgery? PURPOSE: Identify risk factors for adverse outcomes after geriatric lumbar spinal surgery. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients over 80 years old who underwent lumbar spinal surgery in the ACS-NSQIP Database from 2005–2013. OUTCOME MEASURES: Outcome measures studied were major complications, minor complications, readmissions, and mortality. METHODS: A retrospective cohort study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients over the age of 80 who underwent lumbar spinal surgery from 2005–2013 were identified using ICD-9 diagnosis codes and CPT codes. Outcome data were classified as either a major complication, minor complication, readmission, or mortality. Major complications included sepsis, pulmonary embolism, deep surgical site infection, organ or surgical site infection, unplanned intubation, CVA, MI, cardiac arrest, ventilator use >48 hours, septic shock, acute renal failure, peripheral nerve injury, coma, or graft/prosthesis/flap failure. Minor complications included blood transfusion, UTI, DVT, superficial SSI, pneumonia, renal insufficiency, and wound dehiscence. Multivariate logistic regression models were used to determine factors which placed the patients at risk to develop adverse outcomes in the initial 30 postoperative days. RESULTS: A total of 2,320 patients over the age of 80 who underwent lumbar spine surgery were identified. Overall, 379 (16.34%) patients experienced at least one complication or death. 75 (3.23%) patients experienced a major complication. 338 (14.57%) patients experienced a minor complication. 86 (6.39%) patients were readmitted to the hospital within 30 days. 10 (0.43%) deaths recorded in the initial 30 postoperative days. Increased operative times were strongly associated with perioperative complications (operative time >180 mins, OR: 3.07 [2.23–4.22] and operative time 120–180 mins, OR: 1.77 [1.27–2.47]. Instrumentation and/or fusion procedures were also associated with increased risk of developing a complication (OR: 2.56 [1.66– 3.94]). Readmission was strongly associated with patients who were considered underweight (BMI <18.5) and who were functionally debilitated at the time of admission (OR: 4.10 [1.08–15.48], OR: 2.79 [1.40–5.56] respectively). CONCLUSIONS: Elderly patients undergoing lumbar spinal surgery have high complications and readmission rates. Risk factors for complications include longer operative time, and more extensive procedures involving instrumentation and fusion. Higher readmission rates are associated with low
baseline patient functional status and low patient BMI Surgeons should remain cognizant of these risk factors and exercise caution when planning lumbar surgery in very elderly patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.209
184. Frailty Index is a Significant Predictor of Complications and Readmissions following Posterior Lumbar Fusion Nathan J. Lee, BS1, Parth Kothari, BS1, Dante M. Leven, DO, PT1, Jeremy Steinberger, MD2, Javier Guzman, MD2, Branko Skovrlj, MD3, Samuel K. Cho, MD4; 1Mount Sinai School of Medicine, New York, NY, USA; 2New York, NY, USA; 3Mount Sinai School of Medicine Department of Neurosurgery, New York, NY, USA; 4Icahn School of Medicine at Mount Sinai, New York, NY, USA BACKGROUND CONTEXT: Frailty index is a measure of health status in aging individuals and is an important factor that can be used to predict morbidity and mortality. The Modified Frailty Index (mFI) has been studied outside of the spine patient population and has been shown to be useful in predicting complications and outcomes. The mFI has not been studied in patients undergoing elective posterior lumbar fusions. PURPOSE: Our objective was to analyze the mFI as potential predictive model for complications, reoperations and readmissions within 30 days following lumbar fusion. STUDY DESIGN/SETTING: Retrospective analysis of prospectively collected data. The mFI was calculated based on the number of positive comorbidities present out of 11 total (described elsewhere by Adams et al). PATIENT SAMPLE: American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. All patients >18 years old undergoing elective posterior lumbar fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or PLF with PLIF or TLIF registered in the database. OUTCOME MEASURES: Readmissions, complications, mortality, perioperative events and reoperations within 30 days. METHODS: This was a retrospective analysis of prospectively collected data from the ACS NSQIP database of patients >18 years old undergoing elective PLF, PLIF, TLIF or PLF with PLIF or TLIF between 2005 and 2012. A previously described mFI was calculated based on number of positive factors out of 11 (based on medical comorbidities). Complications, operative factors, patient factors and mortality were analyzed using univariate and multivariate logistic regression analysis with significance defined as p<.05. Odds ratio (OR) was calculated with a 95% confidence interval. RESULTS: There were 6,094 patients met inclusion criteria. Mean mFI was 0.087 (0–0.54). Increasing mFI score was associated with increased complications, reoperations, prolonged length of stay (LOS), and morbidity (p<.05). As the mFI score increased from 0.27 (3/11 variables present) to ≥0.36 (4/ 11) the rate of any complication increased from 26.8% to 35% (p<.0001), sepsis 2.4% to 5.2% (p<.0001), wound complications 4.4% to 6.5% (p<.0001), unplanned readmissions 4.7% to 20% (p=.02) and urinary tract infection (UTI) 4.1% to 10.4% (p<.0001). An mFI of >/= to 0.36 was an independent predictor of any complication (OR 2.2,1.3–3.7), sepsis (OR 6.3,1.8–21), wound complications (OR 2.9,1.1–8.2), prolonged LOS (OR 2.3,1.4–3.7) and readmission (OR 4.3,1.5–12.7). CONCLUSIONS: Patients with higher mFI scores (≥4/11 variables) are at significantly increased risk of major complications, readmissions and prolonged LOS following elective posterior lumbar fusion. These findings highlight the importance of sound preoperative work-up during surgical planning and this predictive model may be a useful tool during risk stratification. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.210
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.