Skip to main content

Advertisement

SpringerLink
Log in

Revision surgery and mortality following complex spine surgery: 2-year follow-up in a prospective cohort of 679 patients using the Spine AdVerse Event Severity (SAVES) system

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

Abstract

Study design

Prospective study.

Objective

To determine the 2-year risk of revision surgery and all-cause mortality after complex spine surgery, and to assess if prospectively registered adverse events (AE) could predict either outcome.

Summary of background data

Revision surgery and mortality are serious complications to spine surgery. Previous studies of frequency have mainly been retrospective and few studies have employed competing risk survival analyses. In addition, assessment of predictors has focused on preoperative patient characteristics. The effect of perioperative AEs on revision and all-cause mortality risks are not fully understood.

Methods

Between January 1 and December 31, 2013, we prospectively included all patients undergoing complex spine surgery at a single, tertiary institution. Complex spine surgery was defined as conditions deemed too complicated for surgery at a secondary institute, or patients with severe comorbidities requiring multidisciplinary observation and treatment. AEs were registered using the Spine Adverse Event Severity system and patients were followed for minimum 2 years regarding revision surgery and all-cause mortality. Incidences were estimated using competing risk survival analyses and correlation between AEs and either outcome was assessed using proportional odds models.

Results

We included a complete and consecutive cohort of 679 adult and pediatric patients. Demographics, surgical data, AEs, and events of revision or all-cause mortality were registered. The cumulative incidence of 2-year all-cause revision was 19% (16–22%) and all-cause mortality was 15% (12–18%). Deformity surgery was the surgical category with highest incidence of revision and the highest incidence of all-cause mortality was seen in the tumor group. Across surgical categories, cumulative incidences of 2-year revision ranged between 11% (tumor) and 33% (deformity), whilst 2-year all-cause mortality ranged between 3% (deformity) and 33% (tumor). We found that major intraoperative AEs were associated to increased odds of revision. Deep wound infection was associated to increased odds of all-cause mortality.

Conclusions

We report the cumulative incidences of revision surgery and all-cause mortality following complex spine surgery. We found higher incidences of revision compared to previous retrospective studies. Prospectively registered AEs were correlated to increased odds of revision surgery and all-cause mortality. These results may serve as reference for future interventional studies and aid in identifying at-risk patients.

Level of evidence

I.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Nasser R, Yadla S, Maltenfort MG, Harrop JS, Anderson DG, Vaccaro AR et al (2010) Complications in spine surgery. J Neurosurg Spine 13:144–157. https://doi.org/10.3171/2010.3.SPINE09369

    Article  PubMed  Google Scholar 

  2. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265. https://doi.org/10.1001/jama.2010.338

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lee NJ, Kothari P, Phan K, Shin JI, Cutler HS, Lakomkin N et al (2018) Incidence and risk factors for 30-day unplanned readmissions after elective posterior lumbar fusion. Spine (Phila Pa 1976) 43:41–48. https://doi.org/10.1097/BRS.0000000000001586

    Article  Google Scholar 

  4. Desai R, Nayar G, Suresh V, Wang TY, Loriaux D, Martin JR et al (2016) Independent predictors of mortality following spine surgery. J Clin Neurosci 29:100–105. https://doi.org/10.1016/j.jocn.2015.12.012

    Article  PubMed  Google Scholar 

  5. Schoenfeld AJ, Ochoa LM, Bader JO, Belmont PJ (2011) 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 Jt Surg Am 93:1577–1582. https://doi.org/10.2106/JBJS.J.01048

    Article  Google Scholar 

  6. Fehlings MG, Kato S, Lenke LG, Nakashima H, Nagoshi N, Shaffrey CI et al (2018) Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. Spine J 18:1733–1740. https://doi.org/10.1016/j.spinee.2018.02.001

    Article  PubMed  Google Scholar 

  7. Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R et al (2016) Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25:1–14. https://doi.org/10.3171/2015.11.SPINE151036

    Article  PubMed  Google Scholar 

  8. Hallager DW, Karstensen S, Bukhari N, Gehrchen M, Dahl B (2017) Radiographic predictors for mechanical failure after adult spinal deformity surgery. Spine (Phila Pa 1976) 42:E855–E863. https://doi.org/10.1097/BRS.0000000000001996

    Article  Google Scholar 

  9. Puvanesarajah V, Shen FH, Cancienne JM, Novicoff WM, Jain A, Shimer AL et al (2016) Risk factors for revision surgery following primary adult spinal deformity surgery in patients 65 years and older. J Neurosurg Spine 25:486–493. https://doi.org/10.3171/2016.2.SPINE151345

    Article  PubMed  Google Scholar 

  10. Passias PG, Soroceanu A, Yang S, Schwab F, Ames C, Boniello A et al (2016) Predictors of revision surgical procedure excluding wound complications in adult spinal deformity and impact on patient-reported outcomes and satisfaction: a two-year follow-up. J Bone Jt Surg Am 98:536–543. https://doi.org/10.2106/JBJS.14.01126

    Article  Google Scholar 

  11. Inoue S, Khashan M, Fujimori T, Berven SH (2015) Analysis of mechanical failure associated with reoperation in spinal fusion to the sacrum in adult spinal deformity. J Orthop Sci. https://doi.org/10.1007/s00776-015-0729-1

    Article  PubMed  Google Scholar 

  12. Pichelmann MA, Lenke LG, Bridwell KH, Good CR, O’Leary PT, Sides BA (2010) Revision Rates Following Primary Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 35:219–226. https://doi.org/10.1097/BRS.0b013e3181c91180

    Article  Google Scholar 

  13. Street JT, Lenehan BJ, DiPaola CP, Boyd MD, Kwon BK, Paquette SJ et al (2012) Morbidity and mortality of major adult spinal surgery. A prospective cohort analysis of 942 consecutive patients. Spine J 12:22–34. https://doi.org/10.1016/j.spinee.2011.12.003

    Article  PubMed  Google Scholar 

  14. Street JT, Thorogood NP, Cheung A, Noonan VK, Chen J, Fisher CG et al (2013) Use of the Spine Adverse Events Severity System (SAVES) in patients with traumatic spinal cord injury. A comparison with institutional ICD-10 coding for the identification of acute care adverse events. Spinal Cord 51:472–476. https://doi.org/10.1038/sc.2012.173

    Article  CAS  PubMed  Google Scholar 

  15. Karstensen S, Bari T, Gehrchen M, Street J, Dahl B (2016) Morbidity and mortality of complex spine surgery: a prospective cohort study in 679 patients validating the Spine AdVerse Event Severity (SAVES) system in a European population. Spine J 16:146–153. https://doi.org/10.1016/j.spinee.2015.09.051

    Article  PubMed  Google Scholar 

  16. Rampersaud YR, Anderson PA, Dimar JR, Fisher CG (2016) Spinal Adverse Events Severity System, version 2 (SAVES-V2): inter- and intraobserver reliability assessment. J Neurosurg Spine 25:256–263. https://doi.org/10.3171/2016.1.SPINE14808

    Article  PubMed  Google Scholar 

  17. Aalen OO, Johansen S (1978) An empirical transition matrix for non-homogeneous Markov chains based on censored observations. Scand J Stat 5:141–150

    Google Scholar 

  18. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  19. Southern DA, Faris PD, Brant R, Galbraith PD, Norris CM, Knudtson ML et al (2006) Kaplan–Meier methods yielded misleading results in competing risk scenarios. J Clin Epidemiol 59:1110–1114. https://doi.org/10.1016/j.jclinepi.2006.07.002

    Article  PubMed  Google Scholar 

  20. Fine JP (2001) Regression modeling of competing crude failure probabilities. Biostatistics 2:85–97. https://doi.org/10.1093/biostatistics/2.1.85

    Article  CAS  PubMed  Google Scholar 

  21. Eriksson F, Li J, Scheike T, Zhang M-J (2015) The proportional odds cumulative incidence model for competing risks. Biometrics 71:687–695. https://doi.org/10.1111/biom.12330

    Article  PubMed  PubMed Central  Google Scholar 

  22. R Core Team (2017) R: a language and environment for statistical computing. R Foundation Statistical Computing, Vienna, Austria. https://www.r-project.org/n.d. Accessed 22 Nov 2019

  23. Therneau TM, Grambsch PM (2015) A Package for Survival Analysis in R. version 2.38. https://CRAN.R-project.org/package=survival

  24. Gerds TA (2017) Prodlim: product-limit estimation for censored event history analysis. R package version 1.6.1. https://CRAN.R-project.org/package=prodlim

  25. Scheike TH, Zhang M-J (2011) Analyzing competing risk data using the R timereg package. J Stat Softw. https://doi.org/10.18637/jss.v038.i02

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR et al (2015) A comprehensive review of complication rates after surgery for adult deformity: a reference for informed consent. Spine Deform 3:575–594. https://doi.org/10.1016/j.jspd.2015.04.005

    Article  PubMed  Google Scholar 

  27. Sánchez-Mariscal F, Gomez-Rice A, Izquierdo E, Pizones J, Zúñiga L, Álvarez-González P (2014) Survivorship analysis after primary fusion for adult scoliosis. Progn Factors Reoper Spine J 14:1629–1634. https://doi.org/10.1016/j.spinee.2013.09.050

    Article  Google Scholar 

  28. Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D (2012) Complications and risk factors of primary adult scoliosis surgery. Spine (Phila Pa 1976) 37:693–700. https://doi.org/10.1097/BRS.0b013e31822ff5c1

    Article  Google Scholar 

  29. Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK (2011) Revision surgery following operations for lumbar stenosis. J Bone Jt Surg Am 93:1979–1986. https://doi.org/10.2106/JBJS.J.01292

    Article  Google Scholar 

  30. Weinstein JN, Tosteson TD, Lurie JD, Tosteson ANA, Hanscom B, Skinner JS et al (2006) Surgical vs nonoperative treatment for lumbar disk herniation. JAMA 296:2441. https://doi.org/10.1001/jama.296.20.2441

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kreinest M, Rillig J, Grützner PA, Küffer M, Tinelli M, Matschke S (2017) Analysis of complications and perioperative data after open or percutaneous dorsal instrumentation following traumatic spinal fracture of the thoracic and lumbar spine: a retrospective cohort study including 491 patients. Eur Spine J 26:1535–1540. https://doi.org/10.1007/s00586-016-4911-8

    Article  PubMed  Google Scholar 

  32. Fredø HL, Rizvi SAM, Rezai M, Rønning P, Lied B, Helseth E (2016) Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients. BMC Surg 16:56. https://doi.org/10.1186/s12893-016-0172-z

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mesfin A, Sciubba DM, Dea N, Nater A, Bird JE, Quraishi NA et al (2016) Changing the adverse event profile in metastatic spine surgery. Spine (Phila Pa 1976) 41:S262–S270. https://doi.org/10.1097/BRS.0000000000001817

    Article  Google Scholar 

  34. Quraishi NA, Rajabian A, Spencer A, Arealis G, Mehdian H, Boszczyk BM et al (2015) Reoperation rates in the surgical treatment of spinal metastases. Spine J 15:S37–43. https://doi.org/10.1016/j.spinee.2015.01.005

    Article  PubMed  Google Scholar 

  35. Roodman GD (2004) Mechanisms of bone metastasis. N Engl J Med 350:1655–1664. https://doi.org/10.1056/NEJMra030831

    Article  CAS  PubMed  Google Scholar 

  36. Clark PE, Torti FM (2003) Prostate cancer and bone metastases: medical treatment. Clin Orthop Relat Res 415:S148–S157. https://doi.org/10.1097/01.blo.0000093840.72468.e1

    Article  Google Scholar 

  37. Tipsmark LS, Bünger CE, Wang M, Morgen SS, Dahl B, Søgaard R (2015) Healthcare costs attributable to the treatment of patients with spinal metastases: a cohort study with up to 8 years follow-up. BMC Cancer 15:354. https://doi.org/10.1186/s12885-015-1357-z

    Article  PubMed  PubMed Central  Google Scholar 

  38. Morgen SS, Lund-Andersen C, Larsen CF, Engelholm SA, Dahl B (2013) Prognosis in patients with symptomatic metastatic spinal cord compression. Spine (Phila Pa 1976) 38:1362–1367. https://doi.org/10.1097/BRS.0b013e318294835b

    Article  Google Scholar 

  39. Morgen SS, Nielsen DH, Larsen CF, Søgaard R, Engelholm SA, Dahl B (2014) Moderate precision of prognostic scoring systems in a consecutive, prospective cohort of 544 patients with metastatic spinal cord compression. J Cancer Res Clin Oncol 140:2059–2064. https://doi.org/10.1007/s00432-014-1776-2

    Article  PubMed  Google Scholar 

  40. Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198. https://doi.org/10.1097/SLA.0b013e31817f2c1a

    Article  PubMed  Google Scholar 

  41. Kehlet H (2008) Fast-track colorectal surgery. Lancet (London, England) 371:791–793. https://doi.org/10.1016/S0140-6736(08)60357-8

    Article  Google Scholar 

  42. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery. JAMA Surg 152:292. https://doi.org/10.1001/jamasurg.2016.4952

    Article  PubMed  Google Scholar 

  43. Angus M, Jackson K, Smurthwaite G, Carrasco R, Mohammad S, Verma R et al (2019) The implementation of enhanced recovery after surgery (ERAS) in complex spinal surgery. J Spine Surg 5:116–123. https://doi.org/10.21037/jss.2019.01.07

    Article  PubMed  PubMed Central  Google Scholar 

  44. Corniola MV, Debono B, Joswig H, Lemée J-M, Tessitore E (2019) Enhanced recovery after spine surgery: review of the literature. Neurosurg Focus 46:E2. https://doi.org/10.3171/2019.1.FOCUS18657

    Article  PubMed  Google Scholar 

Download references

Funding

No external funding was received.

Author information

Authors and Affiliations

  1. Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Tanvir Johanning Bari, Sven Karstensen, Mathias Dahl Sørensen & Martin Gehrchen

  2. Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Floor 6, Blusson Spinal Cord Center, 818 West 10th Ave., Vancouver, BC, V5Z 1M9, Canada

    John Street

  3. Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital and Baylor College of Medicine, 6621 Fannin St, Houston, TX, 77030, USA

    Benny Dahl

Authors
  1. Tanvir Johanning Bari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sven Karstensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mathias Dahl Sørensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Gehrchen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Street
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Benny Dahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TJB: substantial contributions to the conception or design of the work, substantial contributions to the acquisition, analysis and interpretation of data, revising the work critically for important intellectual content, final approval of the version to be published. SK: substantial contributions to the conception or design of the work, substantial contributions to the analysis and interpretation of data, revising the work critically for important intellectual content, final approval of the version to be published. MDS: substantial contributions to the conception or design of the work, revising the work critically for important intellectual content, final approval of the version to be published. MG: substantial contributions to the conception or design of the work, revising the work critically for important intellectual content, final approval of the version to be published. JS: substantial contributions to the conception or design of the work, revising the work critically for important intellectual content, final approval of the version to be published. BD: substantial contributions to the conception or design of the work, revising the work critically for important intellectual content, final approval of the version to be published.

Corresponding author

Correspondence to Tanvir Johanning Bari.

Ethics declarations

Conflict of interest

BD (consulting fees from K2M outside of the submitted work), MG (institutional grants from K2M and Medtronic outside of the submitted work), JS (research support from Medtronic; Institutional grants form Nserc and Medtronic; Fellowship support from Medtronic and Depuy Synthes all outside the submitted work), the remaining authors report no conflicts of interest.

Ethical approval

This study was approved by the National Health and Medical authority and The National Data Protection Agency.

Informed consent

This study includes no experimental investigation.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bari, T.J., Karstensen, S., Sørensen, M.D. et al. Revision surgery and mortality following complex spine surgery: 2-year follow-up in a prospective cohort of 679 patients using the Spine AdVerse Event Severity (SAVES) system. Spine Deform 8, 1341–1351 (2020). https://doi.org/10.1007/s43390-020-00164-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-020-00164-8

Keywords

Search

Navigation