Skip to main content

Advertisement

Log in

Risk factors for major peri-operative complications in adult spinal deformity surgery: a multi-center review of 953 consecutive patients

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Major peri-operative complications for adult spinal deformity (ASD) surgery remain common. However, risk factors have not been clearly defined. Our objective was to identify patient and surgical parameters that correlate with the development of major peri-operative complications with ASD surgery.

Methods

This is a multi-center, retrospective, consecutive, case–control series of surgically treated ASD patients. All patients undergoing surgical treatment for ASD at eight centers were retrospectively reviewed. Each center identified 10 patients with major peri-operative complications. Randomization tables were used to select a comparably sized control group of patients operated during the same time period that they did not suffer major complications. The two groups were analyzed for differences in clinical and surgical factors. Analysis was restricted to non-instrumentation related complications.

Results

At least one major complication occurred in 80 of 953 patients (8.4 %), including 72 patients with non-instrumentation related complications. There were no significant differences between the complications and control groups based on the demographics, ASA grade, co-morbidities, body mass index, prior surgeries, pre-operative anemia, smoking, operative time or ICU stay (p > 0.05). Hospital stay was significantly longer for the complications group (14.4 vs. 7.9 days, p = 0.001). The complications group had higher percentages of staged procedures (46 vs. 37 %, p = 0.011) and combined anterior–posterior approaches (56 vs. 32 %, p = 0.011) compared with the control group.

Conclusion

The major peri-operative complication rate was 8.4 % for 953 surgically treated ASD patients. Significantly higher rates of complications were associated with staged and combined anterior–posterior surgeries. None of the patient factors assessed were significantly associated with the occurrence of major peri-operative complications. Improved understanding of risk profiles and procedure-related parameters may be useful for patient counseling and efforts to reduce complication rates.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Schwab F, Dubey A, Pagala M, Gamez L, Farcy JP (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine (Phila Pa 1976) 28:602–606

    Google Scholar 

  2. Fu KM, Smith JS, Sansur CA, Shaffrey CI (2010) Standardized measures of health status and disability and the decision to pursue operative treatment in elderly patients with degenerative scoliosis. Neurosurgery 66:42–47 (discussion 47)

    Article  PubMed  Google Scholar 

  3. Smith JS, Fu KM, Urban P, Shaffrey CI (2008) Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 9:326–331

    Article  PubMed  Google Scholar 

  4. Aebi M (2005) The adult scoliosis. Eur Spine J 14:925–948

    Article  PubMed  Google Scholar 

  5. Aebi M (2010) Correction and stabilization of a double major adult idiopathic scoliosis from T5/L5. Eur Spine J 19:510–512

    Article  PubMed  Google Scholar 

  6. Aebi M (2012) Less invasive approach to degenerative lumbar deformity surgery. Eur Spine J 21:571–572

    Article  PubMed  Google Scholar 

  7. Glassman SD, Carreon LY, Shaffrey CI, Polly DW, Ondra SL, Berven SH, Bridwell KH (2010) The costs and benefits of nonoperative management for adult scoliosis. Spine (Phila Pa 1976) 35:578–582

    Article  Google Scholar 

  8. Carreon LY, Puno RM, Dimar JR, 2nd, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Jt Surg Am 85-A:2089–2092

    Google Scholar 

  9. Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH (2011) Risk–benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976) 36:817–824

    Article  Google Scholar 

  10. Lamartina C, Petruzzi M (2011) Adult de novo lumbar scoliosis. Posterior instrumented fusion with Smith-Peterson osteotomy, decompression and management of postoperative infection. Eur Spine J 20:1580–1581

    Article  PubMed  Google Scholar 

  11. Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW, Jr, Perra JH, Boachie-Adjei O, Shaffrey CI (2011) Scoliosis Research Society Morbidity and Mortality of adult scoliosis surgery. Spine (Phila Pa 1976) 36:593–597

    Article  Google Scholar 

  12. Schwab F, Farcy JP, Bridwell K, Berven S, Glassman S, Harrast J, Horton W (2006) A clinical impact classification of scoliosis in the adult. Spine (Phila Pa 1976) 31:2109–2114

    Article  Google Scholar 

  13. Aso A (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  14. Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  PubMed  CAS  Google Scholar 

  15. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636

    Article  PubMed  CAS  Google Scholar 

  16. Hariharan S, Zbar A (2006) Risk scoring in perioperative and surgical intensive care patients: a review. Curr Surg 63:226–236

    Article  PubMed  Google Scholar 

  17. Mohamed K, Copeland GP, Boot DA, Casserley HC, Shackleford IM, Sherry PG, Stewart GJ (2002) An assessment of the POSSUM system in orthopaedic surgery. J Bone Joint Surg Br 84:735–739

    Article  PubMed  CAS  Google Scholar 

  18. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976) 34:2171–2178

    Article  Google Scholar 

  19. Li G, Passias P, Kozanek M, Fu E, Wang S, Xia Q, Li G, Rand FE, Wood KB (2009) Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine (Phila Pa 1976) 34:2165–2170

    Article  Google Scholar 

  20. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K (2009) Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976) 34:1693–1698

    Article  Google Scholar 

  21. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, Ondra S, Schwab F, Shainline M, Fu KM, Bridwell K (2009) Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65:86–93 (discussion 93-84)

    Article  PubMed  Google Scholar 

  22. Bess S, Boachie-Adjei O, Burton D, Cunningham M, Shaffrey C, Shelokov A, Hostin R, Schwab F, Wood K, Akbarnia B (2009) Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Spine (Phila Pa 1976) 34:2186–2190

    Article  Google Scholar 

  23. Baron EM, Albert TJ (2006) Medical complications of surgical treatment of adult spinal deformity and how to avoid them. Spine (Phila Pa 1976) 31:S106–S118

    Article  Google Scholar 

  24. Eck KR, Bridwell KH, Ungacta FF, Riew KD, Lapp MA, Lenke LG, Baldus C, Blanke K (2001) Complications and results of long adult deformity fusions down to l4, l5, and the sacrum. Spine (Phila Pa 1976) 26:E182–E192

    Article  CAS  Google Scholar 

  25. Lapp MA, Bridwell KH, Lenke LG, Baldus C, Blanke K, Iffrig TM (2001) Prospective randomization of parenteral hyperalimentation for long fusions with spinal deformity: its effect on complications and recovery from postoperative malnutrition. Spine (Phila Pa 1976) 26:809–817 (discussion 817)

    Article  CAS  Google Scholar 

  26. Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Choi WK, Lee KY, Lee SR (2007) Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976) 32:2232–2237

    Article  Google Scholar 

  27. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Jt Surg Am 90:62–69

    Article  Google Scholar 

  28. Hu SS (2004) Blood loss in adult spinal surgery. Eur Spine J 13(Suppl 1):S3–S5

    Article  PubMed  Google Scholar 

  29. Pull ter Gunne AF, van Laarhoven CJ, Cohen DB (2010) Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J 19:982–988

    Article  PubMed  Google Scholar 

  30. Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine (Phila Pa 1976) 30:1460–1465

    Article  Google Scholar 

  31. Rhee JM, Bridwell KH, Lenke LG, Baldus C, Blanke K, Edwards C, Berra A (2003) Staged posterior surgery for severe adult spinal deformity. Spine (Phila Pa 1976) 28:2116–2121

    Article  Google Scholar 

Download references

Acknowledgment

Research grant from DePuy to fund the International Spine Study Group. IRB approval was obtained from all contributing institutions.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Justin S. Smith.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schwab, F.J., 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 21, 2603–2610 (2012). https://doi.org/10.1007/s00586-012-2370-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2370-4

Keywords

Navigation