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Predictors of morbidity and mortality among patients with cervical spondylotic myelopathy treated surgically

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Abstract

Purpose

The aim of this study is to report and quantify the associated factors for morbidity and mortality following surgical management of cervical spondylotic myelopathy (CSM).

Methods

The Nationwide Inpatient Sample (NIS) database was use to retrospectively review all patients over 25 years of age with a diagnosis of CSM who underwent anterior and/or posterior cervical fusion or laminoplasty between 2001 and 2010. The main outcome measures were total procedure-related complications and mortality. Multivariate regression analysis was used to identify demographic, comorbidity, and surgical parameters associated with increased morbidity and mortality risk [reported as: OR (95 % CI)].

Results

A total of 54,348 patients underwent surgical intervention for CSM with an overall morbidity rate of 9.83 % and mortality rate of 0.43 %. Comorbidities found to be associated with an increased complication rate included: pulmonary circulation disorders [6.92 (5.91–8.12)], pathologic weight loss [3.42 (3.00–3.90)], and electrolyte imbalance [2.82 (2.65–3.01)]. Comorbidities found to be associated with an increased mortality rate included: congestive heart failure [4.59 (3.62–5.82)], pulmonary circulation disorders [11.29 (8.24–15.47)], and pathologic weight loss [5.43 (4.07–7.26)]. Alternatively, hypertension [0.56 (0.46–0.67)] and obesity [0.36 (0.22–0.61)] were found to confer a decreased risk of mortality. Increased morbidity and mortality rates were also identified for fusions of 4–8 levels [morbidity: 1.55 (1.48–1.62), mortality: 1.80 (1.48–2.18)] and for age >65 years [morbidity: 1.65 (1.57–1.72), mortality: 2.74 (2.25–3.34)]. An increased morbidity rate was found for posterior-only [1.55 (1.47–1.63)] and combined anterior and posterior fusions [3.20 (2.98–3.43)], and an increased mortality rate was identified for posterior-only fusions [1.87 (1.40–2.49)]. Although revision fusions were associated with an increased morbidity rate [1.81 (1.64–2.00)], they were associated with a decreased rate of mortality [0.24 (0.10–0.59)].

Conclusion

The NIS database was used to provide national estimates of morbidity and mortality following surgical management of CSM in the United States. Several comorbidities, as well as demographic and surgical parameters, were identified as associated factors.

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References

  1. Montgomery DM, Brower RS (1992) Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop Clin North Am 23:487–493

    CAS  PubMed  Google Scholar 

  2. Lees F, Aldren-Turner JW (1963) Natural history and prognosis of cervical spondylosis. BMJ 2:1607–1610

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Matz PG, Anderson PA, Holly LT, Groff MW, Heary RF, Kaiser MG, Mummaneni PV, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 11:104–111

    Article  PubMed  Google Scholar 

  4. Sampath P, Bendebba M, Davis JD et al (2000) Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine 25:670–676

    Article  CAS  PubMed  Google Scholar 

  5. Kadanka Z, Mares M, Bednanik J et al (2002) Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study. Spine 27:2205–2210 discussion: 2210–2211

    Article  PubMed  Google Scholar 

  6. Fehlings MG, Smith JS, Kopjar B, Arnold PM, Yoon ST, Vaccaro AR, Brodke DS, Janssen ME, Chapman JR, Sasso RC, Woodard EJ, Banco RJ, Massicotte EM, Dekutoski MB, Gokaslan ZL, Bono CM, Shaffrey CI (2012) Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine 16:425–432

    Article  PubMed  Google Scholar 

  7. Fehlings MG, Arvin B (2009) Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome. J Neurosurg Spine 11:97–100

    Article  PubMed  Google Scholar 

  8. Boakye M, Patil CG, Santarelli J, Ho C, Tian W, Lad SP (2008) Cervical spondylotic myelopathy: complications and outcomes after spinal fusion. Neurosurgery 62:455–461

    Article  PubMed  Google Scholar 

  9. Casha S, Engelbrecht HA, DuPlessis SJ, Hurlbert RJ (2004) Suspended laminoplasty for wide posterior cervical decompression and intradural access: results, advantages, and complications. J Neurosurg Spine 1:80–86

    Article  PubMed  Google Scholar 

  10. Edwards CC 2nd, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine 27:1168–1175

    Article  PubMed  Google Scholar 

  11. Holly LT, Matz PG, Anderson PA, Groff MW, Heary RF, Kaiser MG, Mummaneni PV, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK (2009) Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy. J Neurosurg Spine 11:112–118

    Article  PubMed  Google Scholar 

  12. Chagas H, Domingues F, Aversa A, Fonseca ALV, de Souza JM (2005) Cervical spondylotic myelopathy: 10 years of prospective outcome analysis of anterior decompression and fusion. Surg Neurol 64:S1.30–S1.36

    Article  Google Scholar 

  13. Lad SP, Patil CG, Berta S, Santarelli JG, Ho C, Boakye M (2009) National trends in spinal fusion for cervical spondylotic myelopathy. Surg Neurol 71:66–69

    Article  PubMed  Google Scholar 

  14. Liu Y, Qi M, Chen H, Yang L, Wang X, Shi G, Gao R, Wang C, Yuan W (2012) Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J 21:2428–2435

    Article  PubMed Central  PubMed  Google Scholar 

  15. Healthcare Cost and Utilization Project (HCUP): overview of the Nationwide Inpatient Sample (NIS). Agency for Healthcare Research and Quality February 2013; http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 20 Feb 2014

  16. Healthcare Cost and Utilization Project (HCUP): 2010 Introduction to the Nationwide Inpatient Sample (NIS). Agency for Healthcare Research and Quality January 2013; http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2010.jsp. Accessed 20 Feb 2014

  17. Healthcare Cost and Utilization Project (HCUP): HCUP Comorbidity Software. Agency for Healthcare Research and Quality February 2013; www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Accessed 20 Feb 2014

  18. Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, Vaccaro AR, Brodke DS, Shaffrey CI, Smith JS, Woodard EJ, Banco RJ, Chapman JR, Janssen ME, Bono CM, Sasso RC, Dekutoski MB, Gokaslan ZL (2013) Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multicenter study. J Bone Joint Surg Am 95:1651–1658

    Article  PubMed  Google Scholar 

  19. Holly LT, Moftakhar P, Khoo LT, Shamie AN, Wang JC (2008) Surgical outcomes of elderly patients with cervical spondylotic myelopathy. Surg Neurol 69:233–240

    Article  PubMed  Google Scholar 

  20. Wang MC, Chan L, Maiman DJ, Kreuter W, Deyo RA (2007) Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine 32:342–347

    Article  PubMed  Google Scholar 

  21. Tetreault LA, Kopjar B, Vaccaro A, Yoon ST, Arnold PM, Massicotte EM, Fehlings MG (2013) A clinical prediction model to determine outcomes in patients with cervical spondylotic myelopathy undergoing surgical treatment; data from the prospective, multicenter AOSpine Norath America Study. J Bone Joint Surg Am 95:1659–1666

    Article  PubMed  Google Scholar 

  22. Nassr A, Eck JC, Ponnappan RK, Zanoun RR, Donaldson WF 3rd, Kang JD (2012) The incidence of C5 palsy after multilevel cervical decompression procedures: a review of 750 consecutive cases. Spine 37:174–178

    Article  PubMed  Google Scholar 

  23. Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS (2013) Anterior versus posterior approach for the treatment of cervical spondylotic myelopathy. Spine 38(22S):S173–S182

    Article  PubMed  Google Scholar 

  24. Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG (2011) Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine 14:348–355

    Article  PubMed  Google Scholar 

  25. Mosca I, Kenny RA (2014) Exploring differences in prevalence of diagnosed, measured and undiagnosed hypertension: the case of Ireland and the United States of America. Int J Public Health [Epub ahead of print]

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Authors and Affiliations

  1. NYU Hospital for Joint Diseases, 301 E17th St, Room 1402, New York, NY, 10003, USA

    I. David Kaye, Bryan J. Marascalchi, Angel E. Macagno, Virginie A. Lafage, John A. Bendo & Peter G. Passias

Authors
  1. I. David Kaye
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  2. Bryan J. Marascalchi
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  3. Angel E. Macagno
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  4. Virginie A. Lafage
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  5. John A. Bendo
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  6. Peter G. Passias
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Corresponding author

Correspondence to I. David Kaye.

Appendix

Appendix

See Tables 5, 6.

Table 5 Description of multiple logistic regression models
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Table 6 ICD-9-CM codes for procedure-related complications
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David Kaye, I., Marascalchi, B.J., Macagno, A.E. et al. Predictors of morbidity and mortality among patients with cervical spondylotic myelopathy treated surgically. Eur Spine J 24, 2910–2917 (2015). https://doi.org/10.1007/s00586-015-4010-2

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  • DOI: https://doi.org/10.1007/s00586-015-4010-2

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