|Beitragstitel||Spectrum of Perioperative Morbidity and Complications after Spine Surgery in a Swiss University Hospital Setting|
INTRODUCTION: There is a broad spectrum of complications associated with spine surgeries, with differing incidences reported in the literature. While the majority of studies assess complications in the United States, fewer reports are available for European countries. The aim of the present study therefore was to assess the spectrum and incidence of perioperative complications and morbidity in the post-operative period after spine surgical procedures in a Swiss tertiary care setting.
METHODS: Data on clinical and surgical details were collected for patients who consecutively underwent spine surgery in a Swiss university hospital between 05/2014-12/2015. Special focus was set on the details of perioperative morbidity and the analysis of complications in the early postoperative setting (3 months).
RESULTS: A total of 1009 patients who were consecutively operated on the spine, including 32.1% of revision surgeries, met the inclusion criteria. The average age at surgery was 60.9±15.8 years, active smoking was documented in 35.9% of patients, opioid analgesics were used in 26.1%, and systemic steroids in 4.5%. Preoperative ASA assessment revealed an ASA class I in 19.5%, ASA class II in 55.7%, ASA class III in 23.3%, and ASA class IV in 1.5%. Average length of surgery was 145.5±69.9 min, length of postoperative ICU stay was 7.7±13.4 hours, and length of hospital stay 6.1±3.6 days. The most commonly performed intervention was a lumbar decompression (52.2%), followed by lumbar spondylodesis (22.8%). Overall, 179 complications were documented, of which 119 were surgical (66.5%) and 60 medical complications (33.5%). The most common surgical complication was a relapse of symptoms (n=33), followed by wound healing problems (n=24), and implant-associated complications (n=16). The most common medical complication was perioperative anemia (n=18), followed by symptomatic electrolyte derailment (n=10), and cardiac complications (n=7).
CONCLUSIONS: With an aggressive definition of a complication as any kind of irregularity (including re-herniation for example), 12% of surgical and 6% of medical complications could be documented in a tertiary care setting, with around one third of surgeries conducted in previously operated patients. Only a classification that documents both surgical complexity and patients' medical status, and a standardized reporting system of complications will allow quantification of quality of care in different settings in the future.