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

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

Factual Databases
Sex Factors
Spinal Fusion
Age Factors
Scoliosis
Hospital Mortality
Comorbidity
Inpatients
Hospitalization
Morbidity
Mortality
Pulmonary Circulation

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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.
@article{7cae6359658e4b25b9f89a8f3df02cd8,
title = "Predictors of inpatient morbidity and mortality in adult spinal deformity surgery",
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.",
keywords = "Adult spinal deformity, Complications, Morbidity, Mortality, Outcomes",
author = "Nancy Worley and Bryan Marascalchi and Jalai, {Cyrus M.} and Sun Yang and Bassel Diebo and Shaleen Vira and Anthony Boniello and Virginie Lafage and Passias, {Peter G.}",
year = "2016",
month = "3",
day = "1",
doi = "10.1007/s00586-015-4104-x",
language = "English (US)",
volume = "25",
pages = "819--827",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer Verlag",
number = "3",

}

TY - JOUR

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.

PY - 2016/3/1

Y1 - 2016/3/1

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

UR - http://www.scopus.com/inward/record.url?scp=84958753739&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958753739&partnerID=8YFLogxK

U2 - 10.1007/s00586-015-4104-x

DO - 10.1007/s00586-015-4104-x

M3 - Article

VL - 25

SP - 819

EP - 827

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 3

ER -