Timing of complications following posterior cervical fusion

Abstract

Study design: Retrospective cohort study.

Objective: To characterize the timing of complications after posterior cervical fusion.

Summary of background data: Understanding the expected timing of postoperative complications facilitates early diagnosis of potential adverse events and is important for optimizing postoperative care. Though studies have examined the incidence of complications after posterior cervical fusion, no study has characterized the timing of these complications.

Methods: Patient data in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) dataset with a primary CPT code 22600, corresponding to posterior cervical fusion, was analyzed for demographics, comorbidities, and ten specific complications. Complication timing was assessed, and univariate analysis was performed to investigate the relationship of patient demographic and clinical variables on the development of postoperative complications.

Results: A total of 2517 patients with a mean age of 59.3 ± 12.5 met inclusion criteria. The overall complication rate was 12.4%. The median day of diagnosis and interquartile range for each complication was: blood transfusion (0.0, 0-0), myocardial infarction (3, 2-7), reintubation (3, 1-9), pneumonia (4, 3-10), deep venous thrombosis (7, 5-16), urinary tract infection (11.5, 5-17.5), sepsis (14, 7-20), pulmonary embolism (14, 8-21), surgical site infection (15, 9-21), and wound dehiscence (15.5, 9-25). Less than 50% deep venous thromboses were diagnosed before discharge, and less than 30% of pulmonary emboli were diagnosed before discharge. On univariate analysis, increased age, decreased functional status, fusing more than one level, current smoker status, diabetes, and CHF were associated with increased complications.

Conclusions: This timing data is useful to the practicing spine surgeon as it provides a guide for when to expect and investigate for specific complications after posterior cervical procedures. It may aid in the early diagnosis of complications and may also assist in healthcare reimbursement negotiations.

Keywords: Cervical fusion; Cervical spine; Complications; Myocardial infarction; Pulmonary embolism; Reimbursement; Surgical site infection; Timing; Transfusion; Urinary tract infection.

Fig. 1

Complication Timing within 30 days of PCF. The light blue boxes represent the second quartile, the dark blue boxes represent the third quartile, and the line separating them represents the median number of days to diagnosis of the complication. The error bars represent the range.

Fig. 2

Complications Diagnosed before Discharge.