TY - JOUR
T1 - Incidence of perioperative medical complications and mortality among elderly patients undergoing surgery for spinal deformity
T2 - Analysis of 3519 patients
AU - Jain, Amit
AU - Hassanzadeh, Hamid
AU - Puvanesarajah, Varun
AU - Klineberg, Eric O.
AU - Sciubba, Daniel M.
AU - Kelly, Michael P.
AU - Hamilton, D. Kojo
AU - Lafage, Virginie
AU - Buckland, Aaron J.
AU - Passias, Peter G.
AU - Protopsaltis, Themistocles S.
AU - Lafage, Renaud
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Kebaish, Khaled M.
N1 - Funding Information:
The International Spine Study Group receives funding from DePuy Synthes for administrative support and data collection. The authors report the following. Dr. Hassanzadeh: support of non–study-related clinical or research effort from Pfizer and from Orthofix; consultant for NuVasive. Dr. Kelly: support of non– study-related clinical or research effort from AOSpine, PCORI, Barnes Jewish Foundation, OREF, and CSRS. Dr. Klineberg: consultant for DePuy Synthes and Stryker; honoraria from K2M; and honoraria and fellowship grant from AOSpine. Dr. V. Lafage: stock ownership in Nemaris Inc.; consultant for NuVasive; support of non–study-related clinical or research effort from DePuy Spine, K2M, Stryker, NuVasive (paid through ISSGF), and SRS; and received teaching/educational support from DePuy Spine, MSD, NuVasive, and K2M. Dr. Passias: consultant for Medicrea and support for educational course work. Dr. Protopsaltis: consultant for Medicrea, Globus, NuVasive, and Innovasis; support of non–study-related clinical or research effort from Cervical Spine Research Society and from Zimmer Biomet. Dr. Sciubba: consultant for Medtronic, DePuy-Synthes, and Globus; ownership in Stryker. Dr. Shaffrey: consultant for Medtronic, NuVasive, Zimmer-Biomet, and K2M; direct stock ownership in NuVasive; patent holder in Medtronic, NuVasive, and Zimmer-Biomet; and support of non–study-related clinical or research effort from DePuy-Synthes. Dr. Smith: consultant for Zimmer-Biomet, NuVasive, and Cerapedics; clinical or research support (includes equipment or material) from DePuy-Synthes/ISSG; support of non–study-related clinical or research effort from DePuy-Synthes/ ISSG; honorarium for course work from K2M; and fellowship funding from NREF and AOSpine.
Publisher Copyright:
© AANS, 2017.
PY - 2017/11
Y1 - 2017/11
N2 - OBJECTIVE: Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS: The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of followup (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS: During the perioperative period, rates of major medical complications were 5.9% for pneumonia, 4.1% for deep venous thrombosis, 3.2% for pulmonary embolism, 2.1% for cerebrovascular accident, 1.8% for myocardial infarction, and 1.0% for congestive heart failure. Mortality rates were 0.9% at 6 weeks and 1.8% at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS: The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1% for congestive heart failure to 5.9% for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.
AB - OBJECTIVE: Using 2 complication-reporting methods, the authors investigated the incidence of major medical complications and mortality in elderly patients after surgery for adult spinal deformity (ASD) during a 2-year follow-up period. METHODS: The authors queried a multicenter, prospective, surgeon-maintained database (SMD) to identify patients 65 years or older who underwent surgical correction of ASD from 2008 through 2014 and had a minimum 2 years of followup (n = 153). They also queried a Centers for Medicare & Medicaid Services claims database (MCD) for patients 65 years or older who underwent fusion of 8 or more vertebral levels from 2005 through 2012 (n = 3366). They calculated cumulative rates of the following complications during the first 6 weeks after surgery: cerebrovascular accident, congestive heart failure, deep venous thrombosis, myocardial infarction, pneumonia, and pulmonary embolism. Significance was set at p < 0.05. RESULTS: During the perioperative period, rates of major medical complications were 5.9% for pneumonia, 4.1% for deep venous thrombosis, 3.2% for pulmonary embolism, 2.1% for cerebrovascular accident, 1.8% for myocardial infarction, and 1.0% for congestive heart failure. Mortality rates were 0.9% at 6 weeks and 1.8% at 2 years. When comparing the SMD with the MCD, there were no significant differences in the perioperative rates of major medical complications except pneumonia. Furthermore, there were no significant intergroup differences in the mortality rates at 6 weeks or 2 years. The SMD provided greater detail with respect to deformity characteristics and surgical variables than the MCD. CONCLUSIONS: The incidence of most major medical complications in the elderly after surgery for ASD was similar between the SMD and the MCD and ranged from 1% for congestive heart failure to 5.9% for pneumonia. These complications data can be valuable for preoperative patient counseling and informed consent.
KW - Adult spinal deformity
KW - Elderly patients
KW - Major medical complications
KW - Medicare claims database
KW - Surgeon-maintained database
UR - http://www.scopus.com/inward/record.url?scp=85032702769&partnerID=8YFLogxK
U2 - 10.3171/2017.3.SPINE161011
DO - 10.3171/2017.3.SPINE161011
M3 - Article
C2 - 28820363
AN - SCOPUS:85032702769
SN - 1547-5654
VL - 27
SP - 534
EP - 539
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 5
ER -