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High Risk Factors to Predict Postoperative Medical Complications in High-Risk Patients Undergoing Degenerative Lumbar Scoliosis
NASS 32nd Annual Meeting Proceedings / The Spine Journal 17 (2017) S176–S272 30-days of discharge. The association between postoperative delirium and 30-day readmission rate was assessed via multivariate logistic regression analysis. RESULTS: Patient demographics and comorbidities were similar between both groups. Elderly patients experiencing postoperative delirium have an increased length of hospital stay (10.47 days vs 5.70 days, p=.0097). Complication rates were similar between the cohorts with the postoperative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were readmitted within 30 days of discharge, with postoperative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs No Delirium: 11.01%, p=.0020). Of the patients experiencing postoperative delirium, 35.29% had a history of depression and 23.53% had a history of anxiety prior to hospitalization. The average number days until diagnosis of postoperative delirium was 5.88 days, and the most common treatment for the delirium was discontinuing the patients’ narcotics (29.4%). In a multivariate logistic regression analysis, postoperative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=.0314). CONCLUSIONS: Elderly patients experiencing postoperative delirium after spine surgery is an independent risk factor for unplanned readmission within 30 days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.039
P39. Morbidity and Mortality of Major Adult Spinal Surgery: An Ambispective Cohort Analysis of 977 Patients Xie En, MD; Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi′an, Shan Xi, China BACKGROUND CONTEXT: Patients admitted at our institution with lumbar spinal stenosis from January 2009 to December 2015 were identified. Patients with full spine adverse events severity system (SAVES) data were included. PURPOSE: Patients admitted at our institution with lumbar spinal stenosis from January 2009 to December 2015 were identified. Patients with full spine adverse events severity system (SAVES) data were included. STUDY DESIGN/SETTING: An Ambispective Cohort Analysis. PATIENT SAMPLE: The study includes 977 patients. OUTCOME MEASURES: Data on uncooperative, preoperative and postoperative adverse events (AEs) were prospectively collected using the SAVES data collection. Logistic regression was utilized to model the likelihood of experiencing at least one AE based on the patient characteristics. The influence of the total number of AEs experienced by a patient and that of each of the most common AEs on length of stay (LOS) was established using Poisson regression. METHODS: Data on all patients undergoing surgery over a 12-month period were prospectively collected using a preoperative morbidity abstraction tool at weekly dedicated mortality and morbidity rounds. Data on uncooperative, preoperative, and postoperative adverse events (AEs) were prospectively collected using the SAVES data collection. Logistic regression was utilized to model the likelihood of experiencing at least one AE based on the patient characteristics. The influence of the total number of AEs experienced by a patient and that of each of the most common AEs on length of stay (LOS) was established using Poisson regression. RESULTS: A total of 977 patients with an age range of 37 to 90 years (mean: 59 years) were included in the final analysis. Some 871 patients were treated operatively. Adverse events occurred 57% of the time in the operatively treated patients and only 11% of the time in the nonoperative group. The most frequent AEs were urinary tract infections (17.7%), neuropathic pain (12.7%), pneumonias (10.8%), delirium (10.7%) and ileus (6.2%). Length of hospital stay increased significantly with pneumonia (p<.01) and delirium (p=.01).
S193
CONCLUSIONS: The presence of neurologic injury and the need for operative fixation of lumbar spinal stenosis lead to a greater risk of AES. Major spinal surgery in the adult is associated with a high incidence of intra- and postoperative complications. We identified a very high rate of previously unrecognized postoperative complications, which adversely affect LOS. Without strict adherence to a prospective data collection system, the exact complexity of this surgery may be significantly underestimated. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.040
P40. High Risk Factors to Predict Postoperative Medical Complications in High-Risk Patients Undergoing Degenerative Lumbar Scoliosis Xie En, MD; Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi′an, Shan Xi, China BACKGROUND CONTEXT: Numerous surgical factors affect the incidence of postoperative medical complications following elective spinal arthrodesis. Because of the inter-relatedness of these factors, it is very difficult for clinicians to accurately risk-stratify individual patients. PURPOSE: Our goal was to develop a scoring system that predicts the rate of major medical complications in patients with significant preoperative medical comorbidities, as a function of four preoperative parameters that are most closely associated with the invasiveness of the surgical intervention. STUDY DESIGN/SETTING: This study used level 2, prognostic retrospective study. PATIENT SAMPLE: The patient sample consisted of 590 patients with American Society of Anesthesiologists (ASA) scores of 3–4 who underwent elective degenerative lumbar scoliosis fusion surgeries from 2012 to 2015. OUTCOME MEASURES: Physiologic risk factors, number of levels fused, complications, operative time, interpretative fluids and estimated blood loss were the outcome measures of this study. METHODS: Risk factors were recorded, and patients who suffered major medical complications within the 30-day postoperative period were identified. We used chi-square tests to identify factors that affect the healing complication rate. These factors were ranked and scored by quartiles. The quartile scores were brought together to form a single composite score. We determined the major medical complication rate for each composite score, and divided the cohort into quartiles again based on score. Pearson linear regression analysis was used to compare the incidence of complications to the score. RESULTS: The number of fused levels, operative time, volume of interpretative fluids, and estimated blood loss influenced the complication rate of patients with ASA scores of 3–4. The quartile ranking of each of the four predictive factors was added, and the sum became the composite score. This score predicted the complication rate in a rectilinear fashion ranging from 7.7% for the lowest risk group to 37.7% for the highest group (r=0.879, p<.05). CONCLUSIONS: Taken together, the four factors, though not independent of one another, proved to be strongly predictive of the major medical complication rate. This score can be used to guide medical management of degenerative lumbar scoliosis fusion surgeries patients with preexisting medical comorbidities. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.041
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.
P39. Morbidity and Mortality of Major Adult Spinal Surgery: An Ambispective Cohort Analysis of 977 Patients Xie En, MD; Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi′an, Shan Xi, China BACKGROUND CONTEXT: Patients admitted at our institution with lumbar spinal stenosis from January 2009 to December 2015 were identified. Patients with full spine adverse events severity system (SAVES) data were included. PURPOSE: Patients admitted at our institution with lumbar spinal stenosis from January 2009 to December 2015 were identified. Patients with full spine adverse events severity system (SAVES) data were included. STUDY DESIGN/SETTING: An Ambispective Cohort Analysis. PATIENT SAMPLE: The study includes 977 patients. OUTCOME MEASURES: Data on uncooperative, preoperative and postoperative adverse events (AEs) were prospectively collected using the SAVES data collection. Logistic regression was utilized to model the likelihood of experiencing at least one AE based on the patient characteristics. The influence of the total number of AEs experienced by a patient and that of each of the most common AEs on length of stay (LOS) was established using Poisson regression. METHODS: Data on all patients undergoing surgery over a 12-month period were prospectively collected using a preoperative morbidity abstraction tool at weekly dedicated mortality and morbidity rounds. Data on uncooperative, preoperative, and postoperative adverse events (AEs) were prospectively collected using the SAVES data collection. Logistic regression was utilized to model the likelihood of experiencing at least one AE based on the patient characteristics. The influence of the total number of AEs experienced by a patient and that of each of the most common AEs on length of stay (LOS) was established using Poisson regression. RESULTS: A total of 977 patients with an age range of 37 to 90 years (mean: 59 years) were included in the final analysis. Some 871 patients were treated operatively. Adverse events occurred 57% of the time in the operatively treated patients and only 11% of the time in the nonoperative group. The most frequent AEs were urinary tract infections (17.7%), neuropathic pain (12.7%), pneumonias (10.8%), delirium (10.7%) and ileus (6.2%). Length of hospital stay increased significantly with pneumonia (p<.01) and delirium (p=.01).
S193
CONCLUSIONS: The presence of neurologic injury and the need for operative fixation of lumbar spinal stenosis lead to a greater risk of AES. Major spinal surgery in the adult is associated with a high incidence of intra- and postoperative complications. We identified a very high rate of previously unrecognized postoperative complications, which adversely affect LOS. Without strict adherence to a prospective data collection system, the exact complexity of this surgery may be significantly underestimated. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.040
P40. High Risk Factors to Predict Postoperative Medical Complications in High-Risk Patients Undergoing Degenerative Lumbar Scoliosis Xie En, MD; Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi′an, Shan Xi, China BACKGROUND CONTEXT: Numerous surgical factors affect the incidence of postoperative medical complications following elective spinal arthrodesis. Because of the inter-relatedness of these factors, it is very difficult for clinicians to accurately risk-stratify individual patients. PURPOSE: Our goal was to develop a scoring system that predicts the rate of major medical complications in patients with significant preoperative medical comorbidities, as a function of four preoperative parameters that are most closely associated with the invasiveness of the surgical intervention. STUDY DESIGN/SETTING: This study used level 2, prognostic retrospective study. PATIENT SAMPLE: The patient sample consisted of 590 patients with American Society of Anesthesiologists (ASA) scores of 3–4 who underwent elective degenerative lumbar scoliosis fusion surgeries from 2012 to 2015. OUTCOME MEASURES: Physiologic risk factors, number of levels fused, complications, operative time, interpretative fluids and estimated blood loss were the outcome measures of this study. METHODS: Risk factors were recorded, and patients who suffered major medical complications within the 30-day postoperative period were identified. We used chi-square tests to identify factors that affect the healing complication rate. These factors were ranked and scored by quartiles. The quartile scores were brought together to form a single composite score. We determined the major medical complication rate for each composite score, and divided the cohort into quartiles again based on score. Pearson linear regression analysis was used to compare the incidence of complications to the score. RESULTS: The number of fused levels, operative time, volume of interpretative fluids, and estimated blood loss influenced the complication rate of patients with ASA scores of 3–4. The quartile ranking of each of the four predictive factors was added, and the sum became the composite score. This score predicted the complication rate in a rectilinear fashion ranging from 7.7% for the lowest risk group to 37.7% for the highest group (r=0.879, p<.05). CONCLUSIONS: Taken together, the four factors, though not independent of one another, proved to be strongly predictive of the major medical complication rate. This score can be used to guide medical management of degenerative lumbar scoliosis fusion surgeries patients with preexisting medical comorbidities. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.041
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.