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. 2025 Feb;34(2):782-787.
doi: 10.1007/s00586-024-08616-9. Epub 2024 Dec 23.

Risk factors for mortality after 3-column osteotomy

Jake Carbone  1 , Amit Ratanpal  1 , Anthony K Chiu  1 , Rohan I Suresh  1 , Bradley Anderson  1 , Bibhas Amatya  1 , Amil Sahai  1 , Brian Shear  1 , Alexander Ruditsky  1 , Sennay Ghenbot  1 , Louis J Bivona  1 , Julio J Jauregui  1 , Daniel L Cavanaugh  1 , Eugene Y Koh  1 , Steven C Ludwig  2
Affiliations

Risk factors for mortality after 3-column osteotomy

Jake Carbone et al. Eur Spine J. 2025 Feb.

Abstract

Purpose: Three-column osteotomies (3COs), such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), are used to surgically correct rigid adult spinal deformity (ASD). While extensive research exists about complications associated with 3COs, there remains a paucity of studies analyzing risk factors for mortality following 3CO. We believe the mortality rate after 3-column osteotomy will be low with specific identifiable demographic or medical risk factors.

Methods: A retrospective analysis was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing 3CO were identified via CPT codes. The primary outcome of interest was 30-day postoperative mortality. Univariate statistical analysis was performed, followed by multivariable logistic regression controlling for age, sex, and body mass index (BMI).

Results: The analysis included 1,441 patients. 446 patients had thoracic osteotomies, 996 patients had lumbar osteotomies, and 226 had multilevel osteotomies. The overall 30-day mortality rate was 1.2% (18 patients). On univariate analysis, mortality was more likely in patients with diabetes (2.8% vs. 1.2%, P = 0.029) and COPD (7.0% vs. 1.2%, P < 0.001). Mortality was associated with higher 5-factor modified frailty index (P = 0.004). After controlling for age, sex, and BMI, multivariable analysis revealed that mortality rates were independently associated with longer operative times (OR = 1.28, 95% CI:1.06-1.54, P = 0.010) and COPD (OR = 10.36, 95% CI: [2.17-49.47], P = 0.003).

Conclusion: Thirty-day mortality after 3CO is 1.2% globally. The greatest univariate risk factors are diabetes, COPD, and frailty. Regardless of age, sex, or BMI, it was found that COPD and duration of surgery were independently associated with increased rates of mortality.

Keywords: 3 column osteotomy (3CO); Adult spinal deformity (ASD); Mortality; Pedicle subtraction osteotomy (PSO); Vertebral column resection (VCR).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Potential conflicts of interest were revealed for the applicable authors on the title page. As per the author’s knowledge, there are no present financial or non-financial conflicts of interest with the research conducted in this study. As the data was obtained retrospectively from a nationwide database no informed consent was obtained. Competing interests: The following potential competing interests and funding sources have been declared by the authors below. For the remaining authors, none were declared. Brian Shear: Maryland Orthopaedic Association: Board or committee member. Julio Jauregui: Children: Editorial or governing board. Daniel Cavanaugh: Alphatec Spine: Paid consultant; Stock or stock Options. Eugene Koh: Alphatec Spine: Stock or stock Options. Steven Ludwig: AAOS: Board or committee member; Alphatec Spine: IP royalties; Stock or stock Options; American Board of Orthopaedic Surgery, Inc.: Board or committee member; American Orthopaedic Association: Board or committee member; AO Spine North America Spine Fellowship Support: Research support; ASIP, ISD: Stock or stock Options; Atlas Spine: IP royalties; Baxter: Research support; Cervical Spine Research Society: Board or committee member; Contemporary Spine Surgery: Editorial or governing board; DePuy, A Johnson & Johnson Company: IP royalties; LSRS: Board or committee member; MDC: Stock or stock Options; Nuvasive: IP royalties; Paid consultant; Paid presenter or speaker; Stock or stock; Options; OMEGA: Research support; Smiss: Board or committee member; Stryker: IP royalties; The Spine Journal: Editorial or governing board.

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