Predictors of inpatient morbidity and mortality in adult spinal deformity surgery

Nancy Worley, Bryan Marascalchi, Cyrus M. Jalai, Sun Yang, Bassel Diebo, Shaleen Vira, Anthony Boniello, Virginie Lafage, Peter G. Passias

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Purpose: This nationwide study identifies ASD surgical risk factors for morbidity/mortality. Methods: NIS discharges from 2001 to 2010 aged 25+ with scoliosis diagnoses, 4+ levels fused, and procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included. Demographics, comorbidities and procedure-related complications were determined for each subgroup (degenerative, congenital, idiopathic, other). Multivariate analysis reported as [OR (95 % CI)]. Results: 11,982 discharges were identified. Morbidity, excluding device-related, and mortality rates were 50.81 and 0.28 %, respectively. Certain comorbidities were associated with increased morbidity/mortality: congestive heart failure (CHF) [1.62 (1.42–1.84)] [5.67 (3.30–9.73)], coagulopathy [3.52 (3.22–3.85)] [2.32 (1.44–3.76)], electrolyte imbalance [2.65 (2.52–2.79)] [4.63 (3.15–6.81)], pulmonary circulation disorders [9.45 (7.45–11.99)] [8.94 (4.43–18.03)], renal failure [1.29 (1.13–1.47)] [5.51 (2.57–11.82)], and pathologic weight loss [2.38 (2.01–2.81)] [7.28 (4.36–12.14)]. Chronic pulmonary disease was associated with higher morbidity [1.08 (1.02–1.14)]; liver disease was linked to increased mortality [36.09 (16.16–80.59)]. 9+ level fusions had increased morbidity vs 4–8 level fusions [1.69 (1.61–1.78)] and refusions [1.08 (1.02–1.14)]. Idiopathic scoliosis was associated with decreased morbidity vs all other subgroups [0.85 (0.80–0.91)]. Age >65 was associated with increased morbidity and mortality vs 25–64 group [1.09 (1.05–1.14)] [3.49 (2.31–5.29)]. Females had increased morbidity [1.18 (1.13–1.23)] and decreased mortality [0.30 (0.21–0.44)]. Mean comorbidity index (0.55) and age (64.38) for degenerative cohort were higher vs all other subgroups (P < 0.0001). Conclusions: Longer fusions were associated with increased morbidity. Age >65 was associated with increased morbidity/mortality, while females were associated with increased morbidity but decreased mortality. Idiopathic scoliosis had decreased morbidity. Degenerative ASD cases had higher comorbidity indices, potentially due to older age. This study is clinically useful for patient education, surgical decision-making, and optimizing patient outcomes.

Original languageEnglish (US)
Pages (from-to)819-827
Number of pages9
JournalEuropean Spine Journal
Volume25
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Fingerprint

Inpatients
Morbidity
Mortality
Comorbidity
Scoliosis
Spinal Fusion
Pulmonary Circulation
Patient Education
Electrolytes
Lung Diseases
Renal Insufficiency
Liver Diseases
Weight Loss
Decision Making
Chronic Disease
Thorax
Multivariate Analysis
Heart Failure
Demography
Equipment and Supplies

Keywords

  • Adult spinal deformity
  • Complications
  • Morbidity
  • Mortality
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Worley, N., Marascalchi, B., Jalai, C. M., Yang, S., Diebo, B., Vira, S., ... Passias, P. G. (2016). Predictors of inpatient morbidity and mortality in adult spinal deformity surgery. European Spine Journal, 25(3), 819-827. https://doi.org/10.1007/s00586-015-4104-x

Predictors of inpatient morbidity and mortality in adult spinal deformity surgery. / Worley, Nancy; Marascalchi, Bryan; Jalai, Cyrus M.; Yang, Sun; Diebo, Bassel; Vira, Shaleen; Boniello, Anthony; Lafage, Virginie; Passias, Peter G.

In: European Spine Journal, Vol. 25, No. 3, 01.03.2016, p. 819-827.

Research output: Contribution to journalArticle

Worley, N, Marascalchi, B, Jalai, CM, Yang, S, Diebo, B, Vira, S, Boniello, A, Lafage, V & Passias, PG 2016, 'Predictors of inpatient morbidity and mortality in adult spinal deformity surgery', European Spine Journal, vol. 25, no. 3, pp. 819-827. https://doi.org/10.1007/s00586-015-4104-x
Worley, Nancy ; Marascalchi, Bryan ; Jalai, Cyrus M. ; Yang, Sun ; Diebo, Bassel ; Vira, Shaleen ; Boniello, Anthony ; Lafage, Virginie ; Passias, Peter G. / Predictors of inpatient morbidity and mortality in adult spinal deformity surgery. In: European Spine Journal. 2016 ; Vol. 25, No. 3. pp. 819-827.
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abstract = "Purpose: This nationwide study identifies ASD surgical risk factors for morbidity/mortality. Methods: NIS discharges from 2001 to 2010 aged 25+ with scoliosis diagnoses, 4+ levels fused, and procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included. Demographics, comorbidities and procedure-related complications were determined for each subgroup (degenerative, congenital, idiopathic, other). Multivariate analysis reported as [OR (95 {\%} CI)]. Results: 11,982 discharges were identified. Morbidity, excluding device-related, and mortality rates were 50.81 and 0.28 {\%}, respectively. Certain comorbidities were associated with increased morbidity/mortality: congestive heart failure (CHF) [1.62 (1.42–1.84)] [5.67 (3.30–9.73)], coagulopathy [3.52 (3.22–3.85)] [2.32 (1.44–3.76)], electrolyte imbalance [2.65 (2.52–2.79)] [4.63 (3.15–6.81)], pulmonary circulation disorders [9.45 (7.45–11.99)] [8.94 (4.43–18.03)], renal failure [1.29 (1.13–1.47)] [5.51 (2.57–11.82)], and pathologic weight loss [2.38 (2.01–2.81)] [7.28 (4.36–12.14)]. Chronic pulmonary disease was associated with higher morbidity [1.08 (1.02–1.14)]; liver disease was linked to increased mortality [36.09 (16.16–80.59)]. 9+ level fusions had increased morbidity vs 4–8 level fusions [1.69 (1.61–1.78)] and refusions [1.08 (1.02–1.14)]. Idiopathic scoliosis was associated with decreased morbidity vs all other subgroups [0.85 (0.80–0.91)]. Age >65 was associated with increased morbidity and mortality vs 25–64 group [1.09 (1.05–1.14)] [3.49 (2.31–5.29)]. Females had increased morbidity [1.18 (1.13–1.23)] and decreased mortality [0.30 (0.21–0.44)]. Mean comorbidity index (0.55) and age (64.38) for degenerative cohort were higher vs all other subgroups (P < 0.0001). Conclusions: Longer fusions were associated with increased morbidity. Age >65 was associated with increased morbidity/mortality, while females were associated with increased morbidity but decreased mortality. Idiopathic scoliosis had decreased morbidity. Degenerative ASD cases had higher comorbidity indices, potentially due to older age. This study is clinically useful for patient education, surgical decision-making, and optimizing patient outcomes.",
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T1 - Predictors of inpatient morbidity and mortality in adult spinal deformity surgery

AU - Worley, Nancy

AU - Marascalchi, Bryan

AU - Jalai, Cyrus M.

AU - Yang, Sun

AU - Diebo, Bassel

AU - Vira, Shaleen

AU - Boniello, Anthony

AU - Lafage, Virginie

AU - Passias, Peter G.

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N2 - Purpose: This nationwide study identifies ASD surgical risk factors for morbidity/mortality. Methods: NIS discharges from 2001 to 2010 aged 25+ with scoliosis diagnoses, 4+ levels fused, and procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included. Demographics, comorbidities and procedure-related complications were determined for each subgroup (degenerative, congenital, idiopathic, other). Multivariate analysis reported as [OR (95 % CI)]. Results: 11,982 discharges were identified. Morbidity, excluding device-related, and mortality rates were 50.81 and 0.28 %, respectively. Certain comorbidities were associated with increased morbidity/mortality: congestive heart failure (CHF) [1.62 (1.42–1.84)] [5.67 (3.30–9.73)], coagulopathy [3.52 (3.22–3.85)] [2.32 (1.44–3.76)], electrolyte imbalance [2.65 (2.52–2.79)] [4.63 (3.15–6.81)], pulmonary circulation disorders [9.45 (7.45–11.99)] [8.94 (4.43–18.03)], renal failure [1.29 (1.13–1.47)] [5.51 (2.57–11.82)], and pathologic weight loss [2.38 (2.01–2.81)] [7.28 (4.36–12.14)]. Chronic pulmonary disease was associated with higher morbidity [1.08 (1.02–1.14)]; liver disease was linked to increased mortality [36.09 (16.16–80.59)]. 9+ level fusions had increased morbidity vs 4–8 level fusions [1.69 (1.61–1.78)] and refusions [1.08 (1.02–1.14)]. Idiopathic scoliosis was associated with decreased morbidity vs all other subgroups [0.85 (0.80–0.91)]. Age >65 was associated with increased morbidity and mortality vs 25–64 group [1.09 (1.05–1.14)] [3.49 (2.31–5.29)]. Females had increased morbidity [1.18 (1.13–1.23)] and decreased mortality [0.30 (0.21–0.44)]. Mean comorbidity index (0.55) and age (64.38) for degenerative cohort were higher vs all other subgroups (P < 0.0001). Conclusions: Longer fusions were associated with increased morbidity. Age >65 was associated with increased morbidity/mortality, while females were associated with increased morbidity but decreased mortality. Idiopathic scoliosis had decreased morbidity. Degenerative ASD cases had higher comorbidity indices, potentially due to older age. This study is clinically useful for patient education, surgical decision-making, and optimizing patient outcomes.

AB - Purpose: This nationwide study identifies ASD surgical risk factors for morbidity/mortality. Methods: NIS discharges from 2001 to 2010 aged 25+ with scoliosis diagnoses, 4+ levels fused, and procedural codes for anterior and/or posterior thoracic and/or lumbar spinal fusion and refusion were included. Demographics, comorbidities and procedure-related complications were determined for each subgroup (degenerative, congenital, idiopathic, other). Multivariate analysis reported as [OR (95 % CI)]. Results: 11,982 discharges were identified. Morbidity, excluding device-related, and mortality rates were 50.81 and 0.28 %, respectively. Certain comorbidities were associated with increased morbidity/mortality: congestive heart failure (CHF) [1.62 (1.42–1.84)] [5.67 (3.30–9.73)], coagulopathy [3.52 (3.22–3.85)] [2.32 (1.44–3.76)], electrolyte imbalance [2.65 (2.52–2.79)] [4.63 (3.15–6.81)], pulmonary circulation disorders [9.45 (7.45–11.99)] [8.94 (4.43–18.03)], renal failure [1.29 (1.13–1.47)] [5.51 (2.57–11.82)], and pathologic weight loss [2.38 (2.01–2.81)] [7.28 (4.36–12.14)]. Chronic pulmonary disease was associated with higher morbidity [1.08 (1.02–1.14)]; liver disease was linked to increased mortality [36.09 (16.16–80.59)]. 9+ level fusions had increased morbidity vs 4–8 level fusions [1.69 (1.61–1.78)] and refusions [1.08 (1.02–1.14)]. Idiopathic scoliosis was associated with decreased morbidity vs all other subgroups [0.85 (0.80–0.91)]. Age >65 was associated with increased morbidity and mortality vs 25–64 group [1.09 (1.05–1.14)] [3.49 (2.31–5.29)]. Females had increased morbidity [1.18 (1.13–1.23)] and decreased mortality [0.30 (0.21–0.44)]. Mean comorbidity index (0.55) and age (64.38) for degenerative cohort were higher vs all other subgroups (P < 0.0001). Conclusions: Longer fusions were associated with increased morbidity. Age >65 was associated with increased morbidity/mortality, while females were associated with increased morbidity but decreased mortality. Idiopathic scoliosis had decreased morbidity. Degenerative ASD cases had higher comorbidity indices, potentially due to older age. This study is clinically useful for patient education, surgical decision-making, and optimizing patient outcomes.

KW - Adult spinal deformity

KW - Complications

KW - Morbidity

KW - Mortality

KW - Outcomes

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