Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery

Peter G. Passias, Gregory W. Poorman, Edward Delsole, Peter L. Zhou, Samantha R. Horn, Cyrus M. Jalai, Shaleen Vira, Bassel Diebo, Virginie Lafage

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Design: Retrospective cohort study. Objectives: The purpose of this study was to report incidence of cardiopulmonary complications in elective spine surgery, demographic and surgical predictors, and outcomes. Understanding the risks and predictors of these sentinel events is important for risk evaluation, allocation of hospital resources, and counseling patients. Methods: A retrospective review of the National Surgical Quality Improvement Program (NSQIP) was performed on 60 964 patients undergoing elective spine surgery (any region; laminectomy, arthrodesis, discectomy, or laminoplasty) between 2011 and 2013. Incidence of myocardial infarction, cardiac arrest, unplanned reintubation, on ventilator >48 hours, perioperative pneumonia, and pulmonary embolism was measured. Demographic and surgical predictors of cardiopulmonary complications and associated outcomes (length of stay, discharge disposition, and mortality) were measured using binary logistic regression controlling for confounders. Results: Incidence rates per 1000 elective spine patients were 2.1 myocardial infarctions, 1.3 cardiac arrests, 4.3 unplanned intubations, 3.5 on ventilator >48 hours, 6.1 perioperative pneumonia, and 3.7 pulmonary embolisms. In analysis of procedure, diagnosis, and approach risk factors, thoracic cavity (odds ratio = 2.47; confidence interval = 1.95-3.12), scoliosis diagnosis, and combined approach (odds ratio = 1.51; confidence interval = 1.15-1.96) independently added the most risk for cardiopulmonary complication. Cardiac arrest had the highest mortality rate (34.57%). Being on ventilator greater than 48 hours resulted in the greatest increase to length of stay (17.58 days). Conclusions: Expected risk factors seen in the Revised Cardiac Risk Index were applicable in the context of spine surgery. Surgical planning should take into account patients who are at higher risk for cardiopulmonary complications and the implications they have on patient outcome.

Original languageEnglish (US)
Pages (from-to)218-223
Number of pages6
JournalGlobal Spine Journal
Volume8
Issue number3
DOIs
StatePublished - May 1 2018
Externally publishedYes

Fingerprint

Spine
Mechanical Ventilators
Heart Arrest
Pulmonary Embolism
Length of Stay
Incidence
Pneumonia
Odds Ratio
Myocardial Infarction
Demography
Confidence Intervals
Thoracic Cavity
Diskectomy
Laminectomy
Resource Allocation
Mortality
Arthrodesis
Scoliosis
Quality Improvement
Intubation

Keywords

  • cardiac complications
  • intubation
  • National Surgical Quality Improvement Program
  • NSQIP
  • pulmonary complications
  • spine surgery
  • ventilator

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Passias, P. G., Poorman, G. W., Delsole, E., Zhou, P. L., Horn, S. R., Jalai, C. M., ... Lafage, V. (2018). Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery. Global Spine Journal, 8(3), 218-223. https://doi.org/10.1177/2192568217718817

Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery. / Passias, Peter G.; Poorman, Gregory W.; Delsole, Edward; Zhou, Peter L.; Horn, Samantha R.; Jalai, Cyrus M.; Vira, Shaleen; Diebo, Bassel; Lafage, Virginie.

In: Global Spine Journal, Vol. 8, No. 3, 01.05.2018, p. 218-223.

Research output: Contribution to journalArticle

Passias, PG, Poorman, GW, Delsole, E, Zhou, PL, Horn, SR, Jalai, CM, Vira, S, Diebo, B & Lafage, V 2018, 'Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery', Global Spine Journal, vol. 8, no. 3, pp. 218-223. https://doi.org/10.1177/2192568217718817
Passias, Peter G. ; Poorman, Gregory W. ; Delsole, Edward ; Zhou, Peter L. ; Horn, Samantha R. ; Jalai, Cyrus M. ; Vira, Shaleen ; Diebo, Bassel ; Lafage, Virginie. / Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery. In: Global Spine Journal. 2018 ; Vol. 8, No. 3. pp. 218-223.
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