TITLE: Major Complications Following Adult Spinal Deformity Surgery: Is There a High Risk
Patient Profile?
AUTHORS (LAST NAME, FIRST NAME): Hawkinson, Nicola1; Schwab, Frank J.1; Kelly,
Beverly1; Farcy, Jean-Pierre C.1; Mundis, Gregory M.2; Cunningham, Matthew E.3; Akbarnia,
Behrooz A.2; Hostin, Richard 4; Hart, Robert A.10; Boachie-Adjei, Oheneba3; Burton, Douglas
C.5; Klineberg, Eric6; Shaffrey, Christopher I.7; Bess, Shay 8; Study Group, International
Spine 9
INSTITUTIONS (ALL): 1. NYU Hospital for Joint Diseases, New York, NY, USA.
2. San Diego Center for Spinal Disorders, La Jolla, CA, USA.
3. Hospital for Special Surgery, New York, NY, USA.
4. Baylor Scoliosis Center, Plano, TX, USA.
5. University of Kansas Medical Center, Kansas City, KS, USA.
6. University of California - Davis , Sacramento, CA, USA.
7. University of Virginia, Charlottesville, VA, USA.
8. Rocky Mountain Hospital for Children, Denver, CO, USA.
9. ISSG, San Diego, CA, USA.
10. Oregon Health Sciences University, Portland, OR, USA.
ABSTRACT BODY:
Summary (80 words max): Perioperative complications are a major consideration in Adult
Spinal Deformity. This retrospective consecutive multicenter study established patient profile
of subjects with major peri-operative complication. Results revealed that patient profiles may
not be ‘typical’ of high risk patients. Future prospective studies will use this information to
develop a risk scoring system (RS3) for Adult Spinal Deformity patients.
Introduction: Perioperative complication rates for adult spinal deformity (ASD) have been
reported as high as 80%. Reported risk factors include age, co-morbidities, and blood loss.
While risk scores exist in other surgical disciplines, a system is lacking for ASD. The goal of
the study is to identify major peri-operative complications and determine if patient profiles
can be defined in the setting of ASD surgery
Methods: Retrospective, consecutive, multi-center (n=8) review of major peri-operative
(<6wks post-op) complications in ASD patients (documented coronal or sagittal deformity).
Major complications were identified and categorized as: pulmonary, neurological,
cardiovascular, gastrointestinal, and infectious. Clinical chart reviews were conducted to
obtain; ASA grade, co-morbidities, preoperative lab values, and intra/post-operative
parameters. Incidence of complications and patient profiles were described.
Results: 72 patients (18M, 54F) were identified in a review of 953 consecutive ASD patients.
Mean age was 54yo (18-79) with a total incidence of 99 major and 133 minor complications.
Mean operative time was 491mn, mean EBL was 2440ml and mean transfusion was 3100ml
RBC’s. 54% were revision cases (mean 1.9 previous surgeries) and 50% were staged
procedures. 44% of patients were ASA grade III (mean ASA 2.33). There was a mean comorbidity rate of 2.5 per patient. Most common comorbidities were hypertension,
depression/anxiety, coronary artery disease and hypothyroidism. The mean length of ICU
stay was 3.4 days. Most common major complications included excessive (>4L)
intraoperative bleeding (n=11), return to the OR for deep wound infections (n=11) and
pulmonary embolus (n=10)
Conclusion: The inherent risk in ASD surgery may not be avoidable. An improved
understanding of risk profiles in patients and procedure-related parameters is critical. Such
information can assist in pre-operative risk-benefit decisions and pre-emptive approaches to
reduce risk. This study reveals that patients affected by major complications in ASD surgery
may not be ‘typical’ high risk patients. This study will form the basis for a prospective multicenter study and aid in the development of a risk scoring system for ASD (RSSS=RS3)
Cardiac Arrest
Cord Deficit
Death
Nerve Root Injury
Coagulopathy
Vessel Organ injury
Excessive Bleeding if >4liters
Malignant Hyperthermia
Bowel/Bladder deficit
Death
Deep Vein Thrombosis
Cauda Equina Deficit
Infection deep-return to OR
Motor Deficit/ Paralysis
Myocardial Infarction
Neuropathy
Optic Deficit/Blindness
Pneumonia
Pulmonary Embolism
Acute respiratory failure
Sepsisi
Stroke
Acute Respiratory distress Syndrome
Cholecystitis
Pancreatitis
Unplanned return to OR
Prolonged ICU stay*greater thank 72 hr
i
For one or more days after the major operating room procedure code