Incidence and risk factors for major surgical complications in patients with complex spinal deformity

A report from an SRS GOP site

Oheneba Boachie-Adjei, Mitsuru Yagi, Venu M. Nemani, Cristina Sacramento-Dominguez, Harry Akoto, Matthew E. Cunningham, Munish Gupta, William F. Hess, Baron S. Lonner, Michael J. Mendelow, Elias C. Papadopoulus, Federico Sanchez-Perez-Grueso, Feran Pelise, Ken Paonesa, Bettye Wright, Irene Wulff, Han JoKim

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Study Design: Retrospective analysis of a prospectively collected single-center database. Objectives: To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site. Summary of Background Data: Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown. Methods: A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits. Results: Major complications were seen in 85 cases, which consisted of neurologic deficits (n 5 27; 17 transient and 10 permanent), wound infections (n = 17), implant-related problems (n = 35), progressive deformity (n = 13), and death (n = 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA indicated 3-column osteotomies as an independent risk factor for neurological deficit. Curves 100° and above were at higher risk for complications. Conclusions: Postoperative complications were seen in 20% of surgically treated patients with complex spine deformities at a Scoliosis Research Society SRS Global Outreach Program site. Three-column osteotomies were identified as an independent risk factor of both postoperative complications and neurological deficits. The significant observed correlation of 3-column osteotomies and postoperative neurological deficits should serve as a guide for surgeons in the preoperative planning and management of severe spinal deformities, especially in locations with limited resources. Patients undergoing correction of large curves may also have a higher complication rate.

Original languageEnglish
Pages (from-to)57-64
Number of pages8
JournalSpine Deformity
Volume3
Issue number1
DOIs
Publication statusPublished - 2015
Externally publishedYes

Fingerprint

Incidence
Osteotomy
Logistic Models
Regression Analysis
Scoliosis
Spine
Spinal Fusion
Wound Infection
Neurologic Manifestations
Research
Retrospective Studies
Demography
Databases
Pediatrics
Therapeutics

Keywords

  • Complications
  • Global outreach site
  • Kyphosis
  • Osteotomy
  • Scoliosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Incidence and risk factors for major surgical complications in patients with complex spinal deformity : A report from an SRS GOP site. / Boachie-Adjei, Oheneba; Yagi, Mitsuru; Nemani, Venu M.; Sacramento-Dominguez, Cristina; Akoto, Harry; Cunningham, Matthew E.; Gupta, Munish; Hess, William F.; Lonner, Baron S.; Mendelow, Michael J.; Papadopoulus, Elias C.; Sanchez-Perez-Grueso, Federico; Pelise, Feran; Paonesa, Ken; Wright, Bettye; Wulff, Irene; JoKim, Han.

In: Spine Deformity, Vol. 3, No. 1, 2015, p. 57-64.

Research output: Contribution to journalArticle

Boachie-Adjei, O, Yagi, M, Nemani, VM, Sacramento-Dominguez, C, Akoto, H, Cunningham, ME, Gupta, M, Hess, WF, Lonner, BS, Mendelow, MJ, Papadopoulus, EC, Sanchez-Perez-Grueso, F, Pelise, F, Paonesa, K, Wright, B, Wulff, I & JoKim, H 2015, 'Incidence and risk factors for major surgical complications in patients with complex spinal deformity: A report from an SRS GOP site', Spine Deformity, vol. 3, no. 1, pp. 57-64. https://doi.org/10.1016/j.jspd.2014.06.008
Boachie-Adjei, Oheneba ; Yagi, Mitsuru ; Nemani, Venu M. ; Sacramento-Dominguez, Cristina ; Akoto, Harry ; Cunningham, Matthew E. ; Gupta, Munish ; Hess, William F. ; Lonner, Baron S. ; Mendelow, Michael J. ; Papadopoulus, Elias C. ; Sanchez-Perez-Grueso, Federico ; Pelise, Feran ; Paonesa, Ken ; Wright, Bettye ; Wulff, Irene ; JoKim, Han. / Incidence and risk factors for major surgical complications in patients with complex spinal deformity : A report from an SRS GOP site. In: Spine Deformity. 2015 ; Vol. 3, No. 1. pp. 57-64.
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abstract = "Study Design: Retrospective analysis of a prospectively collected single-center database. Objectives: To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site. Summary of Background Data: Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown. Methods: A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits. Results: Major complications were seen in 85 cases, which consisted of neurologic deficits (n 5 27; 17 transient and 10 permanent), wound infections (n = 17), implant-related problems (n = 35), progressive deformity (n = 13), and death (n = 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA indicated 3-column osteotomies as an independent risk factor for neurological deficit. Curves 100° and above were at higher risk for complications. Conclusions: Postoperative complications were seen in 20{\%} of surgically treated patients with complex spine deformities at a Scoliosis Research Society SRS Global Outreach Program site. Three-column osteotomies were identified as an independent risk factor of both postoperative complications and neurological deficits. The significant observed correlation of 3-column osteotomies and postoperative neurological deficits should serve as a guide for surgeons in the preoperative planning and management of severe spinal deformities, especially in locations with limited resources. Patients undergoing correction of large curves may also have a higher complication rate.",
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AU - Cunningham, Matthew E.

AU - Gupta, Munish

AU - Hess, William F.

AU - Lonner, Baron S.

AU - Mendelow, Michael J.

AU - Papadopoulus, Elias C.

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N2 - Study Design: Retrospective analysis of a prospectively collected single-center database. Objectives: To report the incidence of and identify risk factors for perioperative complications in surgically treated pediatric and adult patients with complex spine deformities in an underserved region and Scoliosis Research Society Global Outreach Program site. Summary of Background Data: Surgical treatment for complex spinal deformity is challenging and requires a multidisciplinary approach for optimal management. The incidence and risk factors for major perioperative complications in outreach sites with limited resources are unknown. Methods: A total of 427 consecutive patients who underwent instrumented spinal fusion for complex spinal deformities were reviewed. Clinical, radiographic, and demographic data were reviewed at preoperative and postoperative time points, and potential risk factors for perioperative complications were assessed. The authors performed multivariate logistic regression analysis (LRA) to determine independent risk factors for postoperative complications and neurological deficits. Results: Major complications were seen in 85 cases, which consisted of neurologic deficits (n 5 27; 17 transient and 10 permanent), wound infections (n = 17), implant-related problems (n = 35), progressive deformity (n = 13), and death (n = 6). Among the possible risk factors, univariate LRA indicated 3-column osteotomies as a risk factor for postoperative major complications and multivariate LRA indicated 3-column osteotomies as an independent risk factor for neurological deficit. Curves 100° and above were at higher risk for complications. Conclusions: Postoperative complications were seen in 20% of surgically treated patients with complex spine deformities at a Scoliosis Research Society SRS Global Outreach Program site. Three-column osteotomies were identified as an independent risk factor of both postoperative complications and neurological deficits. The significant observed correlation of 3-column osteotomies and postoperative neurological deficits should serve as a guide for surgeons in the preoperative planning and management of severe spinal deformities, especially in locations with limited resources. Patients undergoing correction of large curves may also have a higher complication rate.

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