A scoring system to predict postoperative medical complications in high-risk patients undergoing elective thoracic/lumbar arthrodesis.
Spine J. 2015 Aug 4;
Authors: Munch JL, Zusman NL, Lieberman EG, Stucke RS, Bell C, Philipp TC, Smith S, Ching AC, Hart RA, Yoo JU
BACKGROUND CONTEXT: Various surgical factors affect the incidence of postoperative medical complications following elective spinal arthrodesis. Due to the inter-relatedness of these factors, it is difficult for clinicians to accurately risk stratify individual patients.
PURPOSE: Our goal was to develop a scoring system that predicts the rate of major medical complications in patients with significant preoperative medical comorbidities, as a function of the four perioperative parameters that are most closely associated with the invasiveness of the surgical intervention.
STUDY DESIGN/SETTING: Level 2, Prognostic Retrospective Study PATIENT SAMPLE: 281 patients with American Society of Anesthesiologists (ASA) scores 3-4 undergoing elective thoracic/lumbar spine fusion surgeries from 2007 – 2011 OUTCOME MEASURES: Physiologic risk factors, number of levels fused, complications, operative time, intraoperative fluids, estimate blood loss METHODS: Risk factors were recorded, and patients who suffered major medical complications within the 30-day postoperative period were identified. We used Chi-Square tests to identify factors that affect the medical complication rate. These factors were ranked and scored by quartiles. The quartile scores were combined to form a single composite score. We determined the major medical complication rate for each composite score, and divided the cohort into quartiles again based on score. A Pearson linear regression analysis was used to compare the incidence of complications to the score. No outside sources of funding were used for this study, and the authors acknowledge no potential conflicts of interest.
RESULTS: The number of fused levels, operative time, volume of intraoperative fluids, and EBLinfluenced the complication rate of ASA 3-4 patients. The composite score was Powered by Editorial Manager® and Preprint Manager® from Aries Systems Corporation determined by the sum of the quartile ranking of these four factors. This score predicted the complication rate in a linear fashion ranging from 7.6% for the lowest risk group to 34.7% the highest group (r=0.998, p<0.001).
CONCLUSIONS: The four factors, though not independent of one another, taken together proved to be strongly predictive of the major medical complication rate. This score can be used guide medical management of thoracic/lumbar spinal arthrodesis patients with pre-existing medical co-morbidities.
PMID: 26253988 [PubMed – as supplied by publisher]