Predicting 30-Day Perioperative Outcomes in Adult Spinal Deformity Patients With Baseline Paralysis or Functional Dependence

Haddy Alas; Rivka C. Ihejirika; Nicholas Kummer; Lara Passfall; Oscar Krol; Cole Bortz; Katherine E. Pierce; Avery Brown; Dennis Vasquez-Montes; Bassel G. Diebo; Carl B. Paulino; Rafael De La Garza-Ramos; Muhammad B. Janjua; Michael C. Gerling; Peter G. Passias

doi:10.14444/8261

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Figure 1
Length of stay in days across functional dependence groups.
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Figure 2
Three of the most common hospital-acquired conditions or “never events” associated with spine surgery patients, stratified across functional dependence groups. Patients with severe functional dependence had the highest rates of urinary tract infection (UTI) and deep venous thrombosis (DVT), whereas patients with moderate functional dependence had the highest rates of surgical site infection (SSI).
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Figure 3
Readmission and implant failure rates across functional dependence groups. Moderate functional dependence patients had the highest rates of readmission; however rates of implant failure did not differ significantly between groups (P > 0.05).

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Table

Demographics, complications, outcomes, and discharge disposition across functional dependence groups. Increasing functional dependence category was analyzed as a predictor for various inferior outcomes with 95% CIs.

Characteristics	Functional Dependence Groups				Increasing Functional Dependence
Characteristics	Independent(N = 39,030)	Moderate(N = 1774)	Severe(N = 186)	P Value	OR	95% CI	P Value
Demographics
Age (y)	57 ± 13	62 ± 14	56 ± 19	<0.001^{^a}	3.41	(2.89–3.95)	<0.001^{^a}
Body mass index (kg/m²)	30 ± 6.5	30 ± 7.8	28 ± 9.5	0.005^{^a}	−0.24	(−0.50 to 0.03)	0.084
Sex (% women)	53%	49%	49%	0.002^{^a}	0.87	(0.80–0.95)	0.001^{^a}
Invasiveness index	6.8 ± 3.9	8.3 ± 4.9	9.0 ± 6.1	<0.001^{^a}	1.37	(1.21–1.53)	<0.001^{^a}
Charlson Comorbidity Index	2.4 ± 1.6	3.4 ± 2.1	3.0 ± 2.3	<0.001^{^a}	0.73	(0.66–0.80)	<0.001^{^a}
Complications
Surgical site infection	1.5%	2.9%	2.2%	<0.001^{^a}	1.48	(1.15–1.90)	0.002^{^a}
Urinary tract infection	1.5%	4.5%	11.3%	<0.001^{^a}	2.45	(2.04–2.95)	<0.001^{^a}
Deep venous thrombosis	1.2%	3.7%	5.4%	<0.001^{^a}	2.12	(1.71–2.63)	<0.001^{^a}
Implant failure	2.2%	2.8%	2.2%	0.140	1.06	(0.82–1.36)	0.668
Clinical outcomes
Inpatient length of stay (d)	3.8 ± 7.6	8.4 ± 9.4	10.9 ± 13	<0.001^{^a}	3.38	(3.08–3.68)	<0.001^{^a}
Any readmission	10.3%	30.2%	2.7%	<0.001^{^a}	2.72	(2.48–2.98)	<0.001^{^a}
Never events overall	4.0%	9.9%	17.7%	<0.001^{^a}	1.97	(1.72–2.26)	<0.001^{^a}
Discharge disposition
Home	77.1%	32.6%	26.9%	<0.001^{^a}	0.21	(0.19–0.23)	<0.001^{^a}
Subacute rehab	7.5%	19.7%	16.7%	<0.001^{^a}	1.63	(1.63–1.45)	<0.001^{^a}
Acute care facility	0.3%	1.5%	3.2%	<0.001^{^a}	2.69	(1.87–3.86)	<0.001^{^a}
Skilled nursing facility	7.1%	17.5%	18.8%	<0.001^{^a}	1.51	(1.33–1.71)	<0.001^{^a}
Expired	0.2%	0.9%	3.8%	<0.001^{^a}	2.54	(1.67–3.84)	<0.001^{^a}