Article Abstract

Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery

Authors: Scott L. Zuckerman, Nikita Lakomkin, Justin S. Smith, Christopher I. Shaffrey, Clinton J. Devin

Abstract

Background: Surgery for adult spinal deformity (ASD) can significantly improve quality of life but is associated with significant risk of morbidity. Among the most devastating potential complications after these operations is death. The current study aims to report the incidence, preoperative factors, and postoperative complications associated with all-cause mortality within 1 year following ASD surgery.
Methods: Adults who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Demographic characteristics were extracted. The primary outcome was death within 1 year of ASD surgery. Propensity score matching was used to control for confounding factors, followed by univariate/multivariable logistic regression to predict the odds of death within 1 year of ASD surgery.
Results: A total of 6,158 patients underwent ASD surgery and 61 (0.99%) died within one year of surgery. Preoperative factors: controlling for age, gender, American Society of Anesthesiologists (ASA) score and postoperative complications, four independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: increased age (OR =1.03; 95% CI, 1.01–1.06; P=0.012), ASA score (OR =4.32; 95% CI, 2.68–6.94; P<0.001), cancer history (OR =7.91; 95% CI, 4.23–14.78; P<0.001) and unintentional weight loss (OR =4.65; 95% CI, 1.68–12.89; P=0.003). Postoperative complications: using propensity score matching and multivariable logistic regression, three independent risk factors were associated with all-cause mortality within 1 year of ASD surgery: pneumonia (OR =4.00; 95% CI, 1.68–9.53), deep venous thrombosis (DVT) (OR =12.76; 95% CI, 1.20–8.10) and unplanned intubation (OR =3.13; 95% CI, 1.15–8.50).
Discussion: Death after elective ASD surgery is a devastating yet uncommon event with an incidence of 1%. Preoperative factors of age, ASA score, cancer history, and unexpected weight loss, along with postoperative complications of pneumonia, DVT, and unplanned intubation were independently associated with all-cause mortality within 1 year of ASD surgery. Interestingly, the potentially more severe complications of sepsis, PE, and MI did not independently predict death.

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