Perioperative adverse events in adult and pediatric spine surgery: A prospective cohort analysis of 364 consecutive patients

Abstract

Introduction: A precise knowledge of the possible Adverse Events (AEs) related to spinal surgical procedures is crucial in clinical practice.

Research question: Purposes of this study are: to determine the prevalence and severity of perioperative AEs associated with pediatric and adult spine surgery in a high volume center; to estimate the impact of perioperative AEs on length of hospital stay (LOS).

Material and methods: This is a prospective, observational, monocenter study, including 346 consecutive patients (294 adults and 52 pediatrics). The SAVES-V2 questionnaire was used to record AEs. The form was updated by the medical staff every time an adverse event was recorded during hospitalization.

Results: 21,2% of pediatric patients and 20,7% of adults had at least 1 perioperative AEs. In adults, dural tear (3.1%) and neuropathic pain (4,8%), were the most frequent intraoperative and postoperative AE, respectively. In pediatric patients, neurologic deterioration was the most frequent postoperative AE. A diagnosis of deformity (p=0.01), an ASA grade equal or superior to 3 (p=0.023) and the procedure 'Posterior Spinal Fusion' (p=0.001) were associated with a higher frequency of AEs. AEs required prolonged LOS in 40 cases, 7 (70%) pediatric patients and 33 (65%) adults.

Discussion and conclusion: The overall prevalence of AEs is 20.8%, and, although the distribution is almost equal between adult and pediatric patients, their severity is related to age, being higher in pediatric patients. Deformities, deformity correction, revision surgery and AP surgery are the most impactful factors. AEs seriously affect hospitalization, with prolonged LOS (mean 6 days).

Keywords: Adverse events; Deformity; Epidemiology; Patient's Safety; Spine surgery.

Fig. 1

Graphical representation of Diagnostic Subgroups for the Adult (left) and Pediatric (Right) Population. Data are reported as Number. DDD, Degenerative Disk Disease; VCF, Vertebral Compression Fracture; NMS, Neuromuscular Scoliosis; NF1, Neurofibromatosis Type 1.

Fig. 2

Case example of a perioperative AE: a 75 yo female was evaluated for severe back pain (VAS back 8, ODI 56). Full spine X-Rays shows a sagittal imbalance (PI-LL 41°, SVA 73 ​mm) (Panel A). The patient was therefore operated for deformity correction with a two stage surgery: first, extreme lateral interbody fusion (XLIF) was performed at L3-L4 and L4-L5; second, a posterior fusion from T10 to pelvis was done, with prophylactic vertebroplasty (VP) at T9 and T10 (Panel B). Seven days after surgery the patient complained of low back pain of sudden onset, so an MRI was performed (Panel C), without any pathological finding. Three days later, the patient developed paraplegya: a whole spine CT scan was performed (Panel D), that showed a fracture of T10 (Chance Fracture, AO B1) (Yellow Arrow); the fracture happened because of the complete ossification of the ALL starting from the level above the end of the instrumentation (White Arrow), thus leaving T10 in between two rigid segments; furthermore, the VP needles could have weakened the pedicles, increasing the risk of a Chance Fracture. The patient underwent emergency surgery with posterior decompression and extension of the instrumentation to T2 (Panel E, F). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)