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Tables
- Table 1
Patient demographic characteristics between minor Clavien complications and severe Clavien complications.
Demographic Minor Clavien Severe Clavien P Value for Minor vs Severe Underwent Adult Spinal Deformity Surgery (N = 3936) Age, y, mean (SD) 60.36 (15.67) 58.82 (16.28) 0.43 58.7 (16.36) Female sex, % 60.50 65 <0.001 63 Body mass index, mean (SD) 28.65 (6.67) 29.06 (6.91) 0.011 28.7 (6.61) Note: Boldface indicates statistical significance at P < 0.05.
Patient Procedural Characteristics Clavien Grade Total P Value Minor Severe Anterior approach 9.08% 13.27% 12.4% 0.036 Posterior approach 72.42% 65.82% 66.67% 0.156 Combined approach 11.37% 14.32% 13.59% 0.09 Anterior decompression 3.33% 5.62% 3.91% <0.001 Posterior decompression 39.43% 35.59% 35.82% 0.694 Iliac fixation 20.17% 19.68% 15.65% <0.001 Osteotomy 33.96% 30.84% 27.11% <0.001 3-Column osteotomy 10.05% 7.29% 6.68% 0.051 Interbody device placement 28.00% 33.74% 31.22% <0.001 Anterior fusion (0.49 [1.31]) 1 Level 10.05% 7.12% 8.50% <0.001 2–3 Levels 4.78% 6.24% 7.10% 0.005 4–7 Levels 3.74% 2.64% 3.40% 0.001 8+ levels 0.69% 0.35% 0.60% 0.026 Posterior fusion (3.87 [4.74]) 1 Level 40.68% 45.43% 32.70% <0.001 2–6 Levels 12.68% 14.59% 15.50% 0.048 7–12 Levels 21.28% 15.38% 16.80% 0.001 13+ Levels 14.35% 11.60% 10.20% <0.001 Anterior lumbar interbody fusion 8.87% 16.61% 13.87% <0.001 Posterior lumbar interbody fusion 79.49% 71.53% 70.81% 0.200 Operative time, min, mean (SD) 387.1 (148.6) 346.6 (159.3) 336.1 (153.9) 0.169 Note: Boldface indicates statistically significant findings at P < 0.05 across complication levels.
Clavien Grades n % of Patient Population % of Clavien Complications Suffered at least 1 complication 2581 65.57% 100% Grade I 0 0% 0% Grade II 1304 33.13% 50.52% Grade III 139 3.50% 5.39% Grade IV 1111 28.20% 43.04% Grade V 27 0.70% 1.05% Outcome Measure Grade II Grade III Grade IV Grade V Total P Value Total length of stay, d 7.36 (4.84) 10.68 (7.8) 7.9 (8.01) 9.07 (6.56) <0.001 Preoperative Prothrombin time, sec 12.03 (1.82) 12.65 (1.59) 12.41 (1.76) 13.64 (1.84) 12.06 (1.97) 0.021 Serum albumin, g/dL 3.93 (0.53) 3.82 (0.53) 4.02 (0.53) 3.56 (0.68) 4.00 (0.54) <0.001 Alkaline phosphatase, IU/L 87.15 (51.39) 91.6 (50.2) 81.73 (31.47) 108.9 (35.8) 84.25 (41.35) 0.009 Total bilirubin, mg/dL 0.59 (0.72) 0.62 (0.58) 0.52 (0.29) 0.57 (0.27) 0.55 (0.55) 0.274 Blood urea nitrogen, mg/dL 16.46 (7.91) 15.44 (7.93) 16.25 (7.15) 18.06 (10) 16.10 (7.44) 0.046 Serum creatinine, mg/dL 0.87 (0.49) 0.88 (0.46) 0.89 (0.49) 0.87 (0.38) 0.88 (0.49) 0.827 Hematocrit, % 38.27 (4.71) 38.45 (4.55) 39.82 (4.85) 36.69 (6.97) 29.31 (4.78) <0.001 International normalized ratio 1.03 (0.31) 1.02 (0.11) 1.02 (0.18) 1.08 (0.12) 1.02 (0.22) 0.54 Partial thromboplastin time, sec 29.5 (5.3) 30.13 (8.58) 29.61 (5.35) 30.17 (4.88) 29.38 (5.24) 0.082 Platelet, ×103/μL 248.2 (74.4) 252.1 (12) 251.2 (74.0) 218.6 (78.6) 250.1 (73.1) 0.173 Serum glutamic-oxaloacetic transaminase, IU/L 3.75 (4.03) 3.40 (3.42) 1.00 (2.35) 2 2.15 (2.92) 0.065 Serum sodium, mEq/L 26.39 (22.3) 26.14 (12.11) 25.59 (18.35) 32.13 (16.38) 25.72 (18.3) 0.444 White blood cells, % 138.7 (3.2) 138.6 (3.2) 139 (3) 138.74 (4.12) 138.8 (3.0) 0.062 Intraoperative red blood cells given, units 7.08 (2.87) 7 (2.38) 7.18 (2.5) 8.52 (4.5) 7.18 (2.65) 0.036 Note: Boldface indicates statistical significance at P < 0.05 across complication levels.
Characteristic Clavien Grade P Value Minor Major Diabetes mellitus 14.5% 54.2% <0.001 Smoking status 14.1% 16.8% 0.526 Cigarette pack-years <0.001 Alcohol consumption, >2 drinks/d 2.4% 4.5% 0.027 Preoperative functional health status 0.967 Independent 93% 94.1% Partially dependent 5.5% 4.7% Totally dependent 1% 0.8% Ventilator-dependent 0.3% 0.2% 0.625 Chronic obstructive pulmonary disease 4.6% 4.7% 0.645 Ascites 0.1% 0.0% 0.202 Congestive heart failure 0.4% 0.3% 0.546 History of myocardial infarction 6 mo prior 0% 0% 0.55 Previous percutaneous coronary intervention 5.1% 9.0% 0.001 Previous cardiac surgery 4.8% 6.0% 0.341 Hypertension 54.7% 49.8% 0.41 Revascularization/amputation for peripheral vascular disease 0.5% 0.3% <0.001 Rest pain/gangrene 0% 0% 0.55 Acute renal failure 0.1% 0.2% 0.063 Preoperative dialysis 0.5% 3.0% <0.001 Impaired sensorium 1% 1.5% 0.131 Hemiplegia 0.5% 3.0% <0.001 Paraplegia 5.3% 9.0% 0.009 Quadraplegia 0.7% 3.0% 0.002 History of transient ischemic attack 1.9% 0% 0.003 Cerebral vascular accident /stroke with neurological deficit 1.7% 1.5% 0.971 Tumor involving central nervous system 1.4% 4.5% <0.001 Disseminated cancer 2.6% 3.0% 0.016 Open wound/wound infection 1.2% 1.4% 0.016 Steroid use for chronic infection 5.1% 5.7% 0.057 >10% Loss body weight in past 6 mo 1% 0.9% 0.111 Bleeding disorders 2.3% 5.1% <0.001 Transfusion <72 h before surgery 2% 0.8% 0.002 Chemotherapy ≤30 d before surgery 1.0% 3.0% 0.001 Radiotherapy in past 90 d 0.5% 0% 0.3 Prior operation within 30 d 8.7% 13.6% 0.002 American Society of Anesthesiologists classification 0.641 1—No disturbance 1.9% 3.1% 2—Mild disturbance 36.9% 40.0% 3—Severe disturbance 57.4% 53.5% 4—Life-threatening disturbance 3.7% 3.3% Note: Boldface indicates statistical significance at P < 0.05 across complication levels.
Variable Final AUC Clavien grade II complications 0.749 American Society of Anesthesiologists score Preoperative hematocrit level Operative room time Any lumbar fusion Posterior lumbar interbody fusion Clavien grade III complications 0.702 Dialysis Time from incision open to incision close Clavien grade IV complications 0.928 Anterior decompression Any lumbar fusion Preoperative sepsis Inpatient length of stay Clavien grade V complications 0.744 Increased preoperative white blood cell count Hemiplegia and paraplegia Preoperative >10% loss body weight in past 6 mo Severe Clavien complications 0.756 Female sex Diabetes mellitus Operative time Central nervous system tumor Osteotomy Cigarette pack-years Anterior fusion Anterior lumbar interbody fusion Abbreviation: AUC, area under the curve.
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