|Beitragstitel||Risk Factors for Perioperative Complications and Morbidity in Spine Surgery: Multivariate Analysis of 1009 Consecutive Patients|
INTRODUCTION: There is a plethora of risk factors described to be associated with the occurrence of perioperative complications in the setting of spine surgery. In order to ensure comprehensive patient informed consent and comparability of quality of care, evidence-based identification of such risk factors is inevitable. The aim of the present study was to identify potential risk factors for peri- and early postoperative complications in the setting of spine surgeries in a large cohort of consecutive patients based on multivariate risk factor analyses. Preliminary results of multiple binary logistic regression models are presented.
METHODS: Demographic, clinical, and surgical data on patients who consecutively underwent spine surgery at a single university hospital between 05/2014 and 12/2015 were analyzed with binary logistic regression models to assess risk factors for (a) hospital stay ≥10 days, (b) post-operative intensive care unit stay ≥24 hours, (c) blood loss >500mL, and incidence of (d) a surgical or (e) medical complication in the early postoperative period.
RESULTS: A total number of 1009 patients (F: 481, M: 528) with an average age at surgery of 60.9±15.7 years underwent a primary (67.9%) or a revision (32.1%) spinal surgery. Binary logistic regression model for (a) a hospital stay >10 days identified surgery at the thoracolumbar junction, intensive care unit (ICU) stay, occurrence of surgical complications, revision surgery, and CRP as associated risk factors. Risk factors for (b) a postoperative ICU stay >24 hours were surgery involving the sacrum, creatinine and ASA class≥3. Risk factors for (c) blood loss >500mL were spondylodesis, surgery involving the lumbosacral spine, age, and length of surgery. Parameters associated with (d) a surgical complication were spondylodesis, male gender, and length of hospitalization, and for (e) a medical complication: high creatinine, blood loss, and steroid use.
CONCLUSIONS: Based on the herein presented results, a higher degree of surgical invasiveness as well as severity of medical comorbidities seem to be significantly associated with an increased risk for perioperative morbidity and/or early postoperative complications. A system for standardized quantification of complexity of a surgical procedure and severity of medical comorbidities is needed for patient risk estimation. More in depth analyzes are subject of further research.