123 - Incidence, Predictors and Outcomes of Pneumonia after Lumbar Spine Sur...

#123 Incidence, Predictors and Outcomes of Pneumonia after Lumbar Spine Surgery

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Postoperative pneumonia is one of the most common infectious complications following surgery. As interest in the area of performance-based medicine expands into the field of spine surgery, studying this adverse event is becoming increasingly important. Currently, there is limited data regarding pre- and intra-operative risk factors that may increase the likelihood of pneumonia following lumbar spine surgery (LSS). As such, the purpose of this study is to identify the incidence and associated risk factors for pneumonia in patients undergoing LSS.

Methods: Patients who underwent a lumbar fusion (LF) or a lumbar decompression (LD) to treat degenerative lumbar spine disease were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. The incidence of postoperative pneumonia was determined and patients with this complication were compared to unaffected patients. Preoperative patient characteristics (demographics, co-morbidities, pre-operative lab values), surgery and hospital outcomes (e.g., operative time, length of stay, 30-day complication rates, and mortality) were compared between groups. Statistical analysis was performed with SPSS v.20 utilizing independent T-tests and χ2-tests for continuous and categorical variables respectively. P-values ≤ 0.05 were considered statistically significant. Logistic regression was performed to identify predictors for postoperative pneumonia.

Results: A total of 22,676 LSS procedures were identified between 2006-2011. There were 85 reported cases of pneumonia following a LSS (0.4%). Patient characteristics found to be more prevalent in patients with postoperative pneumonia included older age, male gender, higher BMI, diabetes, COPD, cardiac disease, hypertension, peripheral vascular disease (PVD) and steroid use (p< 0.05). A greater preoperative creatinine and INR as well as a lower hematocrit were present in those who developed postoperative pneumonia (p< 0.05). In patients who suffered postoperative pneumonia, there was a greater proportion of non-ambulatory surgeries and patients with an ASA class of 3 and 4. Furthermore, this group demonstrated increased number of blood transfusions and longer operative times (p< 0.0001). Patients experiencing a pneumonia following LSS demonstrated a significantly increased hospital length of stay, readmissions, reoperations, reintubations, prolonged intubations, sepsis and mortality (p< 0.005). Statistically significant predictors for postoperative pneumonia included obesity (BMI>30kg/m2) (OR=1.84), history of COPD (OR=2.65), PVD (OR=3.94), and longer operative times (OR=2.10).

Conclusion: Pneumonia is a well-known complication after any surgical procedure. This study demonstrated a 0.4% incidence following lumbar spinal surgery. Multiple preoperative risk factors were identified including obesity, a history of COPD, PVD and increased operative times. Outcomes data, including length of hospital stay and total costs, were significantly greater in patients diagnosed with a postoperative pneumonia. As the number of LSS continues to grow, surgeons should look to optimize preoperative risk factors and improve efficiency in the operating room in order to prevent this costly complication.