[show abstract][hide abstract] ABSTRACT: Analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.
To study perioperative outcomes of circumferential spine surgery performed on either the same or different days of the same hospitalization.
Circumferential spine fusion surgery has been linked to an increased adjusted risk in perioperative morbidity and mortality compared with procedures involving only 1 site. To minimize these risks, some surgeons elect to perform the 2 components of this procedure in separate sessions during the same hospitalization. The value of this approach is uncertain.
Data collected between 1998 and 2006 for the Nationwide Inpatient Sample were analyzed. Hospitalizations during which a circumferential noncervical spine fusion was performed were identified. Patients were divided into those who had their anterior and posterior portion performed on the same and those performed on different days of the same hospitalization. The prevalence of patient and health care system-related demographics was evaluated. Frequencies of procedure-related complications and mortality were determined. Multivariate regression models were created to identify whether timing of procedures was associated with an independent increase in risk for adverse events.
We identified a total of 11,265 entries for circumferential spine fusion. Of those, 71.2% (8022) were operated in 1 session. Complications were more frequent among staged- versus same-day surgery patients (28.4% vs. 21.7%, P < 0.0001). The incidence of venous thrombosis and adult respiratory distress syndrome also increased among staged candidates, while the trend toward higher mortality (0.5% vs. 0.4%) did not reach significance. In the regression model, staged circumferential spine fusions were associated with a 29% increase in the odds morbidity and mortality compared with same-day procedures.
Staging circumferential spine surgery procedures during the same hospitalization offers no mortality benefit and may even expose patients to increased morbidity.
[show abstract][hide abstract] ABSTRACT: Despite increasing utilization of surgical spine fusions, a paucity of literature addressing perioperative complications after revision posterior spinal fusion (RPSF) versus primary posterior spine fusion (PPSF) of the thoracic and lumbar spine exists.
To examine demographics of patients undergoing PPSF and RPSF of the thoracic and lumbar spine, assess the incidence of perioperative morbidity and mortality, and determine independent risk factors for in-hospital death.
Analysis of nationally representative data collected for the National Inpatient Sample (NIS).
All discharges included in the NIS with a procedure code for posterior thoracic and lumbar spine fusion from 1998 to 2006.
In-hospital mortality and morbidity.
Data collected for each year between 1998 and 2006 for the NIS were analyzed. Discharges with a procedure code for thoracic and lumbar spine fusion were included in the sample. The prevalence of patient- as well as health care-related demographics was evaluated by procedure type (primary vs. revision). Frequencies of procedure-related complications and in-hospital mortality were analyzed. Independent predictors for in-hospital mortality were determined.
We identified 222,549 PPSF and 12,474 RPSF discharges between 1998 and 2006. Patients undergoing PPSF were significantly younger (51.23 years; confidence interval [CI]=51.16, 51.31) and had lower average comorbidity indices (0.40; CI=0.39, 0.41) than those undergoing RPSF (52.69 years; CI=52.43, 52.97) and (0.44; CI=0.43, 0.45), p<.0001. The incidence of procedure-related complications was 16.02% among RPSF compared with 13.44% in PPSF patients (p<.0001). In-hospital mortality rates after PPSF were approximately twice those of RPSF (0.28% vs. 0.15%, p=.006). Adjusted risk factors for increased in-hospital mortality included PPSF compared with RPSF, male gender, and increasing age. A number of comorbidities, complications, and specific surgical indications increased the risk for perioperative death.
Despite being performed in generally younger and healthier patients and having lower perioperative morbidity, PPSF procedures are associated with increased mortality compared with RPSF procedures. The findings of this study can be used for risk stratification, accurate patient consultation, and hypothesis formation for future research.
The spine journal: official journal of the North American Spine Society 10/2010; 10(10):881-9. · 2.90 Impact Factor