Influence of Perioperative Complication Severity on 1- and 2-year Outcomes of Low Back Surgery

Overview

Journal J Orthop Traumatol

Specialties Emergency Medicine
Orthopedics

Date 2016 Nov 24

PMID 27878510

Citations 3

Authors

James Grainger

Thomas Hammett

Robert Isaacs

Chad Cook

Affiliations

Soon will be listed here.

Abstract

Background: Several factors potentially influence outcomes of surgery, including perioperative complications. Complications may take many forms and the Clavien-Dindo (CD) classification is designed to categorize them by degree of severity. The aim of this study was to evaluate the influence of perioperative complications by severity categorization on the 1-and 2-year pain and disability outcomes for patients who received low back surgery.

Materials And Methods: Data used for the study involved a purposive sample (N = 477; 8.1%) from a spine outcomes registry of 5876 patients who received spine surgery and encountered complications. All complications were categorized using the CD classification and were collapsed according to distribution frequencies, i.e., Grade I-II and Grade III-V. Adjusted and unadjusted regression analyses were used to determine the association between CD classification and 1- and 2-year outcomes.

Results: The majority of surgical complications were Grade III-V (N = 358; 75.1%), with two incidences in which death occurred. For the unadjusted models, there were no significant associations between CD classification categorizations for 1-year outcomes; however, 2-year outcomes were significantly worse (P <0.05) for those with Grade III-V categorization. When adjusted and controlled for baseline characteristics, CD classification did not influence 1-or 2-year pain and disability outcomes.

Conclusions: When control variables are considered, the severity of perioperative surgical complications does not appear to influence 1- or 2-year pain and disability outcomes.

Level Of Evidence: Level 4.

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References

Kalanithi P, Patil C, Boakye M . National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine (Phila Pa 1976). 2009; 34(18):1963-9. DOI: 10.1097/BRS.0b013e3181ae2243. View

Siam A, Saghir H, Boehm H . Adjacent segment infection after surgical treatment of spondylodiscitis. J Orthop Traumatol. 2015; 17(1):41-51. PMC: 4805639. DOI: 10.1007/s10195-015-0380-9. View

Oberweis B, Nukala S, Rosenberg A, Guo Y, Stuchin S, Radford M . Thrombotic and bleeding complications after orthopedic surgery. Am Heart J. 2013; 165(3):427-33.e1. PMC: 3595114. DOI: 10.1016/j.ahj.2012.11.005. View

Raffo C, Lauerman W . Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine (Phila Pa 1976). 2006; 31(1):99-103. DOI: 10.1097/01.brs.0000192678.25586.e5. View

Schimmel J, Horsting P, De Kleuver M, Wonders G, van Limbeek J . Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010; 19(10):1711-9. PMC: 2989231. DOI: 10.1007/s00586-010-1421-y. View

Cook C, Frempong-Boadu A, Radcliff K, Karikari I, Isaacs R . Older Age and Leg Pain Are Good Predictors of Pain and Disability Outcomes in 2710 Patients Who Receive Lumbar Fusion. HSS J. 2016; 11(3):209-15. PMC: 4773696. DOI: 10.1007/s11420-015-9456-6. View

Rokito S, Schwartz M, Neuwirth M . Deep vein thrombosis after major reconstructive spinal surgery. Spine (Phila Pa 1976). 1996; 21(7):853-8; discussion 859. DOI: 10.1097/00007632-199604010-00016. View

Glassman S, Hamill C, Bridwell K, Schwab F, Dimar J, Lowe T . The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine (Phila Pa 1976). 2007; 32(24):2764-70. DOI: 10.1097/BRS.0b013e31815a7644. View

Weinstein M, McCabe J, Cammisa Jr F . Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord. 2000; 13(5):422-6. DOI: 10.1097/00002517-200010000-00009. View

10.

Carreon L, Puno R, Dimar 2nd J, Glassman S, Johnson J . Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am. 2003; 85(11):2089-92. DOI: 10.2106/00004623-200311000-00004. View

11.

Wang J, Zhou Y . Perioperative complications related to minimally invasive transforaminal lumbar fusion: evaluation of 204 operations on lumbar instability at single center. Spine J. 2013; 14(9):2078-84. DOI: 10.1016/j.spinee.2013.12.016. View

12.

Wilhelm M, Reiman M, Goode A, Richardson W, Brown C, Vaughn D . Psychological Predictors of Outcomes with Lumbar Spinal Fusion: A Systematic Literature Review. Physiother Res Int. 2015; 22(2). DOI: 10.1002/pri.1648. View

13.

Olsen M, Mayfield J, Lauryssen C, Polish L, Jones M, Vest J . Risk factors for surgical site infection in spinal surgery. J Neurosurg. 2003; 98(2 Suppl):149-55. View

14.

Kalevski S, Peev N, Haritonov D . Incidental Dural Tears in lumbar decompressive surgery: Incidence, causes, treatment, results. Asian J Neurosurg. 2011; 5(1):54-9. PMC: 3198662. View

15.

Fritzell P, Hagg O, Nordwall A . Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J. 2003; 12(2):178-89. PMC: 3784840. DOI: 10.1007/s00586-002-0493-8. View

16.

McDonnell M, Glassman S, Dimar 2nd J, Puno R, Johnson J . Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am. 1996; 78(6):839-47. DOI: 10.2106/00004623-199606000-00006. View

17.

Deyo R, Gray D, Kreuter W, Mirza S, Martin B . United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976). 2005; 30(12):1441-5. DOI: 10.1097/01.brs.0000166503.37969.8a. View

18.

Nasser R, Yadla S, Maltenfort M, Harrop J, Anderson D, Vaccaro A . Complications in spine surgery. J Neurosurg Spine. 2010; 13(2):144-57. DOI: 10.3171/2010.3.SPINE09369. View

19.

Bagchi K, Mohaideen A, Thomson J, Foley L . Hardware complications in scoliosis surgery. Pediatr Radiol. 2002; 32(7):465-75. DOI: 10.1007/s00247-002-0659-x. View

20.

Bombardier C . Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976). 2000; 25(24):3100-3. DOI: 10.1097/00007632-200012150-00003. View