Rates and Causes of Mortality Associated With Spine Surgery Based on 108,419 Procedures

*Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA †Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO ‡Departments of Orthopedic Surgery and Neurosurgery, University of Minnesota, Minneapolis, MN §Spine Surgery Associates, Chattanooga, TN ¶Leatherman Spine Center, Louisville, KY ‖Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA **Department of Neurosurgery, University of California San Francisco, San Francisco, CA.
Spine (Impact Factor: 2.3). 04/2012; 37(23):1975-1982. DOI: 10.1097/BRS.0b013e318257fada
Source: PubMed


STUDY DESIGN.: A retrospective review of a prospectively collected database. OBJECTIVE.: To assess rates and causes of mortality associated with spine surgery. SUMMARY OF BACKGROUND DATA.: Despite the best of care, all surgical procedures have inherent risks of complications, including mortality. Defining these risks is important for patient counseling and quality improvement. METHODS.: The Scoliosis Research Society Morbidity and Mortality database was queried for spinal surgery cases complicated by death from 2004 to 2007, including pediatric (younger than 21 yr) and adult (21 yr or older) patients. Deaths occurring within 60 days and complications within 60 days of surgery that resulted in death were assessed. RESULTS.: A total of 197 mortalities were reported among 108,419 patients (1.8 deaths per 1000 patients). Based on age, rates of death per 1000 patients for adult and pediatric patients were 2.0 and 1.3, respectively. Based on primary diagnosis (available for 107,996 patients), rates of death per 1000 patients were as follows: 0.9 for degenerative (n = 47,393), 1.8 for scoliosis (n = 26,421), 0.9 for spondylolisthesis (n = 11,421), 5.7 for fracture (n = 6706), 4.4 for kyphosis (n = 3600), and 3.3 for other (n = 12,455). The most common causes of mortality included: respiratory/pulmonary causes (n = 83), cardiac causes (n = 41), sepsis (n = 35), stroke (n = 15), and intraoperative blood loss (n = 8). Death occurred prior to hospital discharge for 109 (79%) of 138 deaths for which this information was reported. The specific postoperative day (POD) of death was reported for 94 (48%) patients and included POD 0 (n = 23), POD 1-3 (n = 17), POD 4-14 (n = 30), and POD >14 (n = 24). Increased mortality rates were associated with higher American Society of Anesthesiologists score, spinal fusion, and implants (P < 0.001). Mortality rates increased with age, ranging from 0.9 per 1000 to 34.3 per 1000 for patients aged 20 to 39 years and 90 years or older, respectively. CONCLUSION.: This study provides rates and causes of mortality associated with spine surgery for a broad range of diagnoses and includes assessments for adult and pediatric patients. These findings may prove valuable for patient counseling and efforts to improve the safety of patient care.

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Available from: Ching-Jen Chen, Apr 05, 2014
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    • "However, because patients over 50 years constitute the majority of this group, systemic diseases often coexist in addition to a possible significant surgical time with blood loss and other complications which result in longer and more intensive rehabilitation times [1] [32]. General complication rate is 39%, with 26% of patients undergoing a second operation [1] [7] [8]. Especially for posterior fusion and instrumentation for degenerative lumbar scoliosis, Cho et al. report complication rates of 68%, with abundant blood loss being a significant risk factor for early perioperative complications that included ileus, urinary tract infection, transient delirium, superficial infection, and neurologic deficit [33]. "
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