Timing of Complications Occurring Within 30 Days After Adult Spinal Deformity Surgery

Abstract

Study design: Cross-sectional study of a national surgical database.

Objective: To investigate the timing of complications after adult spinal deformity (ASD) surgery.

Summary of background data: There is limited data on the range of days when complications after ASD surgery occur.

Methods: The American College of Surgeons National Surgical Quality Improvement database was reviewed for the years 2007-2013. Inclusion criteria were adult patients (over 21 years of age) who underwent spinal fusion for ASD. Ten unique complications occurring within 30 postoperative days were examined and the median day to diagnosis was recorded.

Results: A total of 1,250 patients met inclusion criteria with an overall complication rate of 13.5%. The median day of diagnosis (and interquartile range) for each complication was as follows: myocardial infarction (3.5, 1-5), pulmonary embolism (4, 2-16), reintubation (4.5, 1-11), pneumonia (6, 3-9), urinary tract infection (11, 5-15), sepsis (12, 6-18.5), deep vein thrombosis (12, 6-19), deep surgical site infection (SSI; 18.5, 13-23), superficial SSI (19, 13-24), and organ space SSI (21, 17-25). The three complications that were most commonly diagnosed before hospital discharge included pneumonia, reintubation, and myocardial infarction (diagnosed before discharge on more than 70% of cases). On the other hand, superficial, deep, and organ space infection were diagnosed in less than 40% of cases before patients left the hospital. On univariate analysis, predictors of complication occurrence included older age (p = .014), instrumentation of 7-12 levels (p = .034), and instrumentation of 13 or more levels (p = .035).

Conclusion: Understanding the timing of specific complications after adult spinal deformity surgery is important for both patients and clinicians. Efforts in prevention of such conditions should continue, as well as heightened awareness during the periods of highest risk.

Keywords: Adult spinal deformity; Complications; National Surgical Quality Improvement database; Spinal fusion; Timing.