Article Figures & Data
Figures
- Figure 1
Adjusted odds ratios of mortality for selected preoperative risk factors. Age is given in years. COPD, chronic obstructive pulmonary disease.
- Figure 2
Adjusted odds ratio of sepsis/septic shock for selected preoperative risk factors. Age is given in years. COPD, chronic obstructive pulmonary disease.
- Figure 3
Adjusted odds ratios of surgical site infection for selected preoperative risk factors. COPD, chronic obstructive pulmonary disease.
Tables
Code Description 22600 Arthrodesis, posterior or posterolateral technique, single level 63001 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, 1 or 2 vertebral segments 63015 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, 2 or more vertebral segments 63035 Laminotomy of one cervical interspace with decompression of the nerve root(s) 63040 Laminotomy of each additional cervical or lumbar interspace with decompression of the nerve root(s) 63043 Laminotomy of each additional cervical interspace with decompression of the nerve root(s) 63045 Single cervical vertebral laminectomy, facetectomy, and foraminotomy 63050 Laminoplasty with decompression of the spinal cord and includes 2 vertebral segments 63051 Cervical laminoplasty with decompression of the spinal cord and includes 2 or more vertebral segments with reconstruction of the posterior bony elements 63275 Laminectomy for biopsy/excision of intraspinal neoplasm Abbreviation: CPT, Current Procedural Terminology.
- Table 2
Patient demographic, comorbidity, and preoperative characteristics in American College of Surgeons National Surgical Quality Improvement Program patients undergoing posterior cervical decompression with or without fusion.
Variable Normal (GNRI >98) Moderately Malnourished (GNRI 92–98) Severely Malnourished (GNRI <92) P Age, y, median (IQR) 72 (68−76) 73 (68−79) 74 (69−80) <0.001 BMI, kg/m2, median (IQR) 28.7 (25.5–32.4) 28.3 (24.7–32.5) 26.3 (22.1–31.3) <0.001 Gender Male 2900 (58.5%) 820 (56.5%) 685 (57.9%) 0.402 Female 2061 (41.5%) 632 (43.5%) 499 (42.1%) BMI cohorts, kg/m2 Underweight (<18.5) 24 (0.5%) 34 (2.3%) 79 (6.7%) <0.001 Normal weight (18.5–24.9) 1042 (21.0%) 359 (24.7%) 410 (34.6%) Overweight (25.0–29.9) 1908 (38.5%) 491 (33.8%) 350 (29.6%) Obese (>30.0) 1987 (40.1%) 568 (39.1%) 345 (29.1%) Age cohorts, y 65–81 4367 (88.0%) 1189 (81.9%) 906 (76.5%) <0.001 81+ 594 (12.0%) 263 (18.1%) 278 (23.5%) Race White 3821 (81.7%) 1030 (76.4%) 753 (70.8%) <0.001 Black 446 (9.0) 185 (12.8) 184 (15.6) Hispanic 412 (8.3) 133 (9.2) 127 (10.2) Other 277 (5.6) 102 (7.0) 118 (10.0) Admission status Inpatient 4202 (84.7%) 1290 (88.8%) 1135 (95.9%) <0.001 Outpatient 759 (15.3%) 162 (11.2%) 49 (4.1%) Comorbidities Smoking history 525 (10.6%) 210 (14.5%) 192 (16.2%) <0.001 Diabetes mellitus 1315 (26.5) 429 (29.5) 350 (29.6) 0.018 Hypertension requiring medication 3660 (73.8%) 1102 (75.9%) 872 (73.6%) 0.243 Cerebrovascular accident/transient ischemic attack 34 (0.7%) 14 (1.0%) 18 (1.5%) 0.019 Hemiplegia/quadraplegia/paraplegia 33 (0.7%) 19 (1.3%) 24 (2.0%) <0.001 Steroid use 275 (5.5%) 126 (8.7%) 128 (10.8%) <0.001 >10% weight loss within past 6 mo 28 (0.6%) 20 (1.4%) 50 (4.2%) <0.001 Disseminated cancer 102 (2.1%) 45 (3.1%) 95 (8.0%) <0.001 Pulmonary comorbidity 583 (11.8%) 246 (16.9%) 218 (18.4%) <0.001 Dyspnea 357 (7.2) 135 (9.3) 96 (8.1) 0.027 Ventilator dependent 7 (0.1) 13 (0.9) 47 (4.0) <0.001 Chronic obstructive pulmonary disease 322 (6.5) 143 (9.8) 116 (9.8) <0.001 Cardiac comorbidity 108 (2.2%) 40 (2.8%) 46 (3.9%) 0.003 Congestive heart failure 36 (0.7) 24 (1.7) 36 (3.0) <0.001 Prior cardiac intervention 44 (!2.4) 10 (10.8) 7 (8.9) 0.655 Previous cardiac surgery 40 (11.2) 9 (9.7) 7 (8.9) 0.784 Renal comorbidity 21 (0.4%) 25 (1.7%) 61 (5.2%) <0.001 Renal failure 2 (0.0) 3 (0.2) 14 (1.2) <0.001 On dialysis 20 (0.4) 24 (1.7) 57 (4.8) <0.001 ASA class > 3 3476 (70.1%) 1164 (80.2%) 1094 (92.3%) <0.001 Surgical specialty Orthopedic surgery 1464 (29.5%) 397 (27.3%) 268 (22.6%) 0.002 Neurosurgery 3479 (70.1%) 1049 (72.2%) 914 (77.2%) Other subspecialty 26 (0.4%) 6 (0.5%) 2 (0.2%) Albumin (g/dL) <3.5 0 (0.0%) 217 (14.9%) 1094 (92.4%) <0.001 3.5–3.79 0 (0.0%) 1127 (77.6%) 70 (5.9%) ≥3.8 4961 (100.0%) 108 (7.4%) 20 (1.7%) ASA classification 1 22 (0.4) 3 (0.2) 3 (0.3) <0.001 2 1459 (29.4) 285 (19.6) 86 (7.3) 3 3188 (64.3) 974 (67.1) 756 (64.0) 4 288 (5.8) 190 (13.1) 338 (28.5) 5 0 (0.0) 0 (0.0) 0 (0.0) Levels of repair Single 4015 (80.5) 1127 (77.6) 897 (75.8) <0.001 Multiple 946 (19.1) 325 (22.4) 287 (24.2) Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; GNRI, geriatric nutritional risk index; IQR, interquartile range.
Note: Data presented as n (%) unless otherwise indicated. P values in boldface indicate statistically significant comparisons.
- Table 3
Unadjusted 30-d postoperative outcomes in American College of Surgeons National Surgical Quality Improvement Program patients undergoing posterior cervical decompression with or without fusion.
Variable Normal Moderate Severe P Any postoperative complication 700 (14.1%) 304 (20.9%) 415 (35.1%) <0.001 Death 45 (0.9%) 35 (2.4%) 82 (6.9%) <0.001 Return to operating room 180 (3.6%) 71 (4.9%) 92 (7.8%) <0.001 Sepsis/septic shock 69 (1.4%) 31 (2.1%) 83 (7.0%) <0.001 Minor complication 507 (10.2%) 206 (14.2%) 288 (24.3%) <0.001 Surgical site infection 97 (2.0%) 36 (2.5%) 38 (3.2%) 0.027 Wound disruption 31 (0.6%) 13 (0.9%) 7 (0.6%) 0.505 Urinary tract infection 131 (2.6%) 53 (3.7%) 62 (5.2%) <0.001 Intraoperative transfusion 293 (5.9%) 130 (9.0%) 212 (17.9%) <0.001 Extended length of stay (≥5 d) 1213 (24.5%) 532 (36.6%) 693 (58.5%) <0.001 Note: P values in boldface indicate statistically significant comparisons.
Outcome Death Sepsis Surgical Site Infection Factor OR 95% CI P OR 95% CI P OR 95% CI P For every one decrease in geriatric nutritional risk index 1.058 1.038–1.078 <0.001 1.058 1.042–1.075 <0.001 1.021 1.004–1.041 0.016 For every one decrease in albumin (g/L) 1.086 1.056–1.117 <0.001 1.091 1.066–1.186 <0.001 1.032 1.004–1.060 0.023 For every one increase in age (y) 1.061 1.033–1.089 <0.001 1.007 0.984–1.031 0.536 0.970 0.944–0.996 0.022 For every one decrease in body mass index 0.989 0.961–1.019 0.475 0.998 0.978–1.003 0.612 1.032 1.008–1.056 0.008 Note: P values in boldface indicate statistically significant comparisons.
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