TY - JOUR
T1 - Assessment of Postoperative Outcomes of Spine Fusion Patients With History of Cardiac Disease
AU - Ahmad, Waleed
AU - Fernandez, Laviel
AU - Bell, Joshua
AU - Krol, Oscar
AU - Kummer, Nicholas
AU - Passfall, Lara
AU - Naessig, Sara
AU - Pierce, Katherine
AU - Tretiakov, Peter
AU - Moattari, Kevin
AU - Joujon-Roche, Rachel
AU - Williamson, Tyler K.
AU - Imbo, Bailey
AU - Vira, Shaleen
AU - Lafage, Virginie
AU - Paulino, Carl
AU - Schoenfeld, Andrew J.
AU - Diebo, Bassel
AU - Hassanzadeh, Hamid
AU - Passias, Peter
N1 - Publisher Copyright:
Copyright © 2022 by the American Academy of Orthopaedic Surgeons.
PY - 2022/4/15
Y1 - 2022/4/15
N2 - INTRODUCTION: There is paucity on the effect of different cardiac diagnoses on outcomes in elective spine fusion patients. METHODS: Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having a previous history of coronary artery disease (CAD), congestive heart failure (CHF), valve disorder (valve), dysrhythmia, and no heart disease (control). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, length of stay, complication outcomes, and total hospital charges among the cohort. RESULTS: In total, 537,252 elective spine fusion patients were stratified into five groups: CAD, CHF, valve, dysrhythmia, and control. Among the cohort, patients with CHF had significantly higher rates of morbid obesity, peripheral vascular disease, and chronic kidney disease (P < 0.001 for all). Patients with CAD had significantly higher rates of chronic obstructive pulmonary disease, diabetes, hypertension, and hyperlipidemia (all P < 0.001). Comparing postoperative outcomes for CAD and control subjects, CAD was associated with higher odds of myocardial infarction (odds ratio [OR]: 1.64 [1.27 to 2.11]) (P < 0.05). Assessing postoperative outcomes for CHF versus control subjects, patients with CHF had higher rates of pneumonia, cerebrovascular accident (CVA), myocardial infarction, sepsis, and death (P < 0.001). Compared with control subjects, CHF was a significant predictor of death in spine fusion patients (OR: 2.0 [1.1 to 3.5], P = 0.022). Patients with valve disorder compared with control displayed significantly higher rates of 30-day readmission (P < 0.05) and 1.38× greater odds of CVA by 90 days postoperatively (OR: 1.4 [1.1 to 1.7], P = 0.007). Patients with dysrhythmia were associated with significantly higher odds of CVA (OR: 1.8 [1.4 to 2.3], P < 0.001) by 30 days postoperatively. CONCLUSION: Heart disease presents an additional challenge to spine fusion patients who are undergoing a challenging and risky procedure. Before surgical intervention, a proper understanding of cardiac diagnoses could give insight into the potential risks for each patient based on their heart condition and preventive measures showing benefit in minimizing perioperative complications after elective spine fusion.
AB - INTRODUCTION: There is paucity on the effect of different cardiac diagnoses on outcomes in elective spine fusion patients. METHODS: Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having a previous history of coronary artery disease (CAD), congestive heart failure (CHF), valve disorder (valve), dysrhythmia, and no heart disease (control). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, length of stay, complication outcomes, and total hospital charges among the cohort. RESULTS: In total, 537,252 elective spine fusion patients were stratified into five groups: CAD, CHF, valve, dysrhythmia, and control. Among the cohort, patients with CHF had significantly higher rates of morbid obesity, peripheral vascular disease, and chronic kidney disease (P < 0.001 for all). Patients with CAD had significantly higher rates of chronic obstructive pulmonary disease, diabetes, hypertension, and hyperlipidemia (all P < 0.001). Comparing postoperative outcomes for CAD and control subjects, CAD was associated with higher odds of myocardial infarction (odds ratio [OR]: 1.64 [1.27 to 2.11]) (P < 0.05). Assessing postoperative outcomes for CHF versus control subjects, patients with CHF had higher rates of pneumonia, cerebrovascular accident (CVA), myocardial infarction, sepsis, and death (P < 0.001). Compared with control subjects, CHF was a significant predictor of death in spine fusion patients (OR: 2.0 [1.1 to 3.5], P = 0.022). Patients with valve disorder compared with control displayed significantly higher rates of 30-day readmission (P < 0.05) and 1.38× greater odds of CVA by 90 days postoperatively (OR: 1.4 [1.1 to 1.7], P = 0.007). Patients with dysrhythmia were associated with significantly higher odds of CVA (OR: 1.8 [1.4 to 2.3], P < 0.001) by 30 days postoperatively. CONCLUSION: Heart disease presents an additional challenge to spine fusion patients who are undergoing a challenging and risky procedure. Before surgical intervention, a proper understanding of cardiac diagnoses could give insight into the potential risks for each patient based on their heart condition and preventive measures showing benefit in minimizing perioperative complications after elective spine fusion.
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U2 - 10.5435/JAAOS-D-21-00850
DO - 10.5435/JAAOS-D-21-00850
M3 - Article
C2 - 35297795
AN - SCOPUS:85128246911
SN - 1067-151X
VL - 30
SP - e683-e689
JO - The Journal of the American Academy of Orthopaedic Surgeons
JF - The Journal of the American Academy of Orthopaedic Surgeons
IS - 8
ER -