Abstract
Study design
Analysis of the Nationwide Inpatient Sample (NIS) from 1998 to 2008.
Objective
To analyze the most recent available and nationally representative data for risk factors contributing to in-hospital mortality after primary lumbar spine fusion.
Summary of background data
The total number of lumbar spine fusion surgeries has increased dramatically over the past decades. While the field of spine fusion surgery remains highly dynamic with changes in perioperative care constantly affecting patient care, recent data affecting rates and risk for perioperative mortality remain very limited.
Methods
We obtained the NIS from the Hospital cost and utilization project. The impact of patient and health care system related demographics, including various comorbidities as well as postoperative complications on the outcome of in-hospital mortality after spine fusion were studied. Furthermore, we analyzed the timing of in-hospital mortality.
Results
An estimated total of 1,288,496 primary posterior lumbar spine fusion procedures were performed in the US between 1998 and 2008. The average mortality rate for lumbar spine fusion surgery was 0.2 %. Independent risk factors for in-hospital mortality included advanced age, male gender, large hospital size, and emergency admission. Comorbidities associated with the highest in-hospital mortality after lumbar spine fusion surgery were coagulopathy, metastatic cancer, congestive heart failure and renal disease. Most lethal complications were cerebrovascular events, sepsis and pulmonary embolism. Furthermore, we demonstrated that the timing of death occurred relatively early in the in-hospital period with over half of fatalities occurring by postoperative day 9.
Conclusion
This study provides nationally representative information on risk factors for and timing of perioperative mortality after primary lumbar spine fusion surgery. These data can be used to assess risk for this event and to develop targeted intervention to decrease such risk.
Similar content being viewed by others
References
Garrett WE Jr, Swiontkowski MF, Weinstein JN et al (2006) American board of orthopaedic surgery practice of the orthopaedic surgeon: part-II, certification examination case mix. J Bone Joint Surg Am 88:660–667
Oldridge NB, Yuan Z, Stoll JE et al (1994) Lumbar spine surgery and mortality among medicare beneficiaries, 1986. Am J Public Health 84:1292–1298
Ma Y, Passias P, Gaber-Baylis LK et al (2010) Comparative in-hospital morbidity and mortality after revision versus primary thoracic and lumbar spine fusion. Spine J. 10:881–889
Juratli SM, Mirza SK, Fulton-Kehoe D et al (2009) Mortality after lumbar fusion surgery. Spine. 34:740–747
Li G, Patil CG, Lad SP et al (2008) Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine 33:1250–1255
Cowan JA Jr, Dimick JB, Wainess R et al (2006) Changes in the utilization of spinal fusion in the United States. Neurosurgery. 59:15–20
Kalanithi PS, Patil CG, Boakye M (2009) National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine. 34:1963–1969
Walid MS, Robinson JS 3rd, Abbara M, Tolaymat A, Robinson JS Jr (2011) De novo spine surgery as a predictor of additional spine surgery at the same or distant spine regions. Ger Med Sci 9:Doc10
Deyo RA, Cherkin DC, Loeser JD et al (1992) Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am 74:536–543
HCUP Databases. Healthcare cost and utilization project (HCUP) (2008) Agency for healthcare research and quality, Rockville. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 15 Mar 2010
Introduction to the HCUP national inpatient sample (NIS) 2006 (2008) Agency for healthcare research and quality, healthcare cost and utilization project (HCUP). Rockville. http://www.hcup-us.ahrq.gov/db/nation/nis/2006NIS_INTRODUCTION.pdf. Accessed 15 Mar 2010
HCUP comorbidity software healthcare cost and utilization project (HCUP) (2009) Agency for healthcare research and quality, Rockville. http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Accessed 15 Oct 2010
Harrell FE (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis, 1st edn. Springer-Verlag, New York, pp 215–265
Sauerbrei W, Schimacher M (1992) A bootstrap resampling procedure for model building: application to the cox regression model. Stat Med 11(20):93–109
Gonen M (2007) Analyzing receiver operating characteristic curves with SAS, 1st edn. SAS Institute Inc, Cary
Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley, New York
Memtsoudis SG, Vougioukas VI, Ma Y, et al (2010) Perioperative morbidity and mortality after anterior, posterior, and anterior/posterior spine fusion surgery. Spine (Epub ahead of print)
Li G, Patil CG, Lad SP et al (2008) Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine 33:1250–1255
Farjoodi P, Skolasky RL, Riley LH 3rd (2011) The effects of hospital and surgeon volume on postoperative complications after lumbar spine surgery. Spine. (epub ahead of print)
Raffo CS, Lauerman WC (2006) Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine. 31:99–103
Memtsoudis SG, Della Valle AG, Besculides MC et al (2010) Risk factors for perioperative mortality after lower extremity arthroplasty: a population-based study of 6,901,324 patient discharges. J Arthroplasty 25:19–26 epub 2008 Dec 23
Parvizi J, Mui A, Purtill JJ et al (2007) Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am 89:27–32
Acknowledgments
This study was performed with funds from the Hospital for the Department of Anesthesiology at the Hospital for Special Surgery (Stavros G. Memtsoudis) and Center for Education and Research in Therapeutics (CERTs) (AHRQ RFA-HS-05-14) (Ya-lin Chiu) and Clinical Translational Science Center (CTSC) (NIH UL1-RR024996) (Yan Ma).
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pumberger, M., Chiu, Y.L., Ma, Y. et al. Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors. Eur Spine J 21, 1633–1639 (2012). https://doi.org/10.1007/s00586-012-2298-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-012-2298-8