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In-hospital complications and mortality after elective spinal fusion surgery in the united states: a study of the nationwide inpatient sample from 2001 to 2005.

Abstract：

:Spinal fusion surgery has increased dramatically and patients presenting for surgery are often more medically challenging. We hypothesized that advanced age and coexisting morbidities have increased in the population undergoing spinal fusion and are associated with greater risks for immediate complications and mortality. The Nationwide Inpatient Sample was retrospectively reviewed for discharges after a principal procedure code for elective spinal fusion. Total records meeting study inclusion criteria were 254,640. Coexisting morbidities were tabulated using Elixhauser comorbidities and the Charlson comorbidity index. Logistic regression identified risk factors associated with in-hospital mortality and early complications. The largest increase in spinal fusion surgery was in patients >65 years. Overall, those with at least 1 comorbidity increased (49% to 62%; P=0.002), as did mean Charlson index (0.146 to 0.202; P<0.001). In-hospital mortality was 0.13%, but 0.29%, and 0.64% for patients of 65 to 74, and those >or=75 years, respectively. Adjusted odds ratios for complications in 65-year to 74-year olds versus <65 years was 1.78 (95% confidence interval, 1.71-1.84; P<0.001), and for mortality 3.81 (95% confidence interval, 2.62-5.55; P<0.001); risks increased with the number of coexisting morbidities. Congestive heart failure, chronic pulmonary disease, coagulopathy, metastatic cancer, renal failure, and weight loss significantly correlated with in-hospital mortality, whereas hypertension or hypothyroidism had, unexpectedly, the opposite effect. Although it is known for some other forms of complex surgery, we showed that elderly and medically complex spinal fusion patients were at increased risk for in-hospital mortality and early complications. The majority of complications were operative, pulmonary, cardiovascular, or genito-urinary. Patient risk correlated with the number and nature of coexisting morbidities.

journal_name

J Neurosurg Anesthesiol

journal_title

Journal of neurosurgical anesthesiology

authors

Shen Y,Silverstein JC,Roth S

doi

10.1097/ANA.0b013e31818b47e9

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

21-30

issue

eissn

0898-4921

issn

1537-1921

pii

00008506-200901000-00005

journal_volume

pub_type

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In-hospital complications and mortality after elective spinal fusion surgery in the united states: a study of the nationwide inpatient sample from 2001 to 2005.