Skip to main content
SpringerLink
Log in

Timing of Complications Occurring Within 30 Days After Adult Spinal Deformity Surgery

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Cross-sectional study of a national surgical database.

Objective

To investigate the timing of complications after adult spinal deformity (ASD) surgery.

Summary of Background Data

There is limited data on the range of days when complications after ASD surgery occur.

Methods

The American College of Surgeons National Surgical Quality Improvement database was reviewed for the years 2007–2013. Inclusion criteria were adult patients (over 21 years of age) who underwent spinal fusion for ASD. Ten unique complications occurring within 30 postoperative days were examined and the median day to diagnosis was recorded.

Results

A total of 1,250 patients met inclusion criteria with an overall complication rate of 13.5%. The median day of diagnosis (and interquartile range) for each complication was as follows: myocardial infarction (3.5, 1–5), pulmonary embolism (4, 2–16), reintubation (4.5, 1–11), pneumonia (6, 3–9), urinary tract infection (11, 5–15), sepsis (12, 6–18.5), deep vein thrombosis (12, 6–19), deep surgical site infection (SSI; 18.5, 13–23), superficial SSI (19, 13–24), and organ space SSI (21, 17–25). The three complications that were most commonly diagnosed before hospital discharge included pneumonia, reintubation, and myocardial infarction (diagnosed before discharge on more than 70% of cases). On the other hand, superficial, deep, and organ space infection were diagnosed in less than 40% of cases before patients left the hospital. On univariate analysis, predictors of complication occurrence included older age (p = .014), instrumentation of 7–12 levels (p = .034), and instrumentation of 13 or more levels (p = .035).

Conclusion

Understanding the timing of specific complications after adult spinal deformity surgery is important for both patients and clinicians. Efforts in prevention of such conditions should continue, as well as heightened awareness during the periods of highest risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Smith JS, Lafage V, Shaffrey CI, et al. Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery 2016;78:851–61.

    Article  Google Scholar 

  2. Sciubba DM, Scheer JK, Yurter A, et al. Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management. Eur Spine J 2016;25:2433–41.

    Article  Google Scholar 

  3. Scheer JK, Smith JS, Clark AJ, et al. Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction. J Neurosurg Spine 2015;22:540–53.

    Article  Google Scholar 

  4. Sciubba DM, Yurter A, Smith JS, et al. A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 2015;3:575–94.

    Article  Google Scholar 

  5. Smith JS, Klineberg E, Lafage V, et al. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 2016;25:1–14.

    Article  Google Scholar 

  6. Bianco K, Norton R, Schwab F, et al. Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 2014;36:E18.

    Article  Google Scholar 

  7. Schwab FJ, Hawkinson N, Lafage V, et al. Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients. Eur Spine J 2012;21:2603–10.

    Article  Google Scholar 

  8. De la Garza Ramos R, Passias PG, Schwab F, et al. Incidence, risk factors, and mortality of reintubation in adult spinal deformity surgery. Clin Spine Surg 2016 [Epub ahead of print].

  9. De la Garza-Ramos R, Passias PG, Schwab FJ, et al. The effect of July admission on inpatient morbidity and mortality after adult spinal deformity surgery. Int J Spine Surg 2016;10:3.

    Article  Google Scholar 

  10. Carreon LY, Puno RM, Dimar 2nd JR, et al. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 2003;85:2089–92.

    Article  Google Scholar 

  11. Bohl DD, Webb ML, Lukasiewicz AM, et al. Timing of complications after spinal fusion surgery. Spine (Phila Pa 1976) 2015;40:1527–35.

    Article  Google Scholar 

  12. Shiloach M, Frencher Jr SK, Steeger JE, et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010;210:6–16.

    Article  Google Scholar 

  13. Schoenfeld AJ, Le HV, Marjoua Y, et al. Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS). Spine J 2016;16:482–90.

    Article  Google Scholar 

  14. Schoenfeld AJ, Ochoa LM, Bader JO, Belmont Jr PJ. Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Joint Surg Am 2011;93:1577–82.

    Article  Google Scholar 

  15. Schoenfeld AJ, Wahlquist TC. Mortality, complication risk, and total charges after the treatment of epidural abscess. Spine J 2015;15:249–55.

    Article  Google Scholar 

  16. De la Garza-Ramos R, Abt NB, Kerezoudis P, et al. Deep-wound and organ-space infection after surgery for degenerative spine disease: an analysis from 2006 to 2012. Neurol Res 2016;38:117–23.

    Article  Google Scholar 

  17. Abt NB, De la Garza-Ramos R, Olorundare IO, et al. Thirty day postoperative outcomes following anterior lumbar interbody fusion using the national surgical quality improvement program database. Clin Neurol Neurosurg 2016;143:126–31.

    Article  Google Scholar 

  18. De la Garza Ramos R, Goodwin CR, Qadi M, et al. The impact of smoking on 30-day morbidity and mortality in adult spinal deformity surgery. Spine (Phila Pa 1976) 2016 [Epub ahead of print].

  19. De la Garza-Ramos R, Jain A, Kebaish KM, et al. Inpatient morbidity and mortality after adult spinal deformity surgery in teaching versus nonteaching hospitals. J Neurosurg Spine 2016;25:15–20.

    Article  Google Scholar 

  20. Di Capua J, Somani S, Kim JS, et al. Hospital acquired conditions (HACs) in adult spinal deformity surgery: predictors for HACs and other 30-day postoperative outcomes. Spine (Phila Pa 1976) 2016 [Epub ahead of print].

  21. Phan K, Kim JS, Somani S, et al. Impact of age on 30-day complications after adult deformity surgery. Spine (Phila Pa 1976) 2016 [Epub ahead of print].

  22. Park SJ, Lee CS, Chung SS, et al. Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity: survivorship analysis of 160 patients. Neurosurgery 2016 [Epub ahead of print].

  23. Cho KJ, Suk SI, Park SR, et al. Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J 2008;17:650–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21287, USA

    Rafael De la Garza Ramos MD, C. Rory Goodwin MD, PhD & Daniel M. Sciubba MD

  2. Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Ave, Bronx, NY, 10467, USA

    Rafael De la Garza Ramos MD

  3. Division of Spinal Surgery, NYU Medical Center-Hospital for Joint Diseases, 306 East 15th Street, Ground Floor, New York, NY, 10003, USA

    Peter G. Passias MD

  4. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA

    Brian J. Neuman MD & Khaled M. Kebaish MD

  5. Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Virginie Lafage PhD & Frank Schwab MD

Authors
  1. Rafael De la Garza Ramos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Rory Goodwin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter G. Passias MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brian J. Neuman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khaled M. Kebaish MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Virginie Lafage PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Frank Schwab MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel M. Sciubba MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rafael De la Garza Ramos MD.

Additional information

Author disclosures

RDGR (none); CRG (is a UNCF Merck Postdoctoral Fellow and has received an award from the Burroughs Wellcome Fund and the Johns Hopkins Neurosurgery Pain Research Institute); PGP (none); BJN (none); KMK (none); VL (none); FS (none); DMS (consulting relationships with Medtronic, Globus, DePuy-Synthes, and Orthofix).

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. The authors have no conflicts of interest. Timing of Complications Occurring within 30 Days after Adult Spinal Deformity Surgery.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De la Garza Ramos, R., Goodwin, C.R., Passias, P.G. et al. Timing of Complications Occurring Within 30 Days After Adult Spinal Deformity Surgery. Spine Deform 5, 145–150 (2017). https://doi.org/10.1016/j.jspd.2016.10.009

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2016.10.009

Keywords

Search

Navigation