154 - Effect of Hypertension in Surgical Outcomes after Cervical Spine Surge...

#154 Effect of Hypertension in Surgical Outcomes after Cervical 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: Hypertension is a prevalent comorbidity among patients undergoing cervical spine surgery (CSS). The purpose of this study was to assess the impact of hypertension with regards to costs, postoperative complications, and mortality after CSS.

Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002-2011. Patients undergoing an elective anterior cervical fusion (ACF), a posterior cervical fusion (PCF) and a posterior cervical decompression (PCD) to treat degenerative cervical pathology were identified and separated into cohorts. Patients with hypertension were identified in each surgical cohort. Patient demographics, comorbidities (CCI), length of stay (LOS), costs and in-hospital complications were analyzed. SPSS v.20 was utilized for statistical analysis with independent T-tests for discrete variables and χ2-tests for categorical data. A multinomial regression analysis determined if hypertension was an independent predictor of postoperative complications after controlling for age, other comorbidities, and hospital variables.

A p-value ≤0.001 denoted statistical significance.

Results: A total of 243,259 cervical spine procedures were identified of which 94,807 (38.9%) demonstrated a preoperative diagnosis of hypertension. Hypertensive patients comprised 37.2%, 53.3% and 46.9% of all ACFs, PCFs and PCDs respectively. In all cohorts, the hypertensive patients were significantly older and demonstrated a greater comorbidity burden than the patients without hypertension (p< 0.001). In addition, hypertensive patients incurred a greater LOS and total hospital costs than normotensive patients. Regardless of the surgical technique, hypertensive patients demonstrated a significantly greater incidence of postoperative urinary tract infections (UTI) and cardiac events (p< 0.001). Additionally, in the ACF cohort, hypertension was also associated with a greater incidence of postoperative hematomas, aspiration, dysphagia, and mortality (p< 0.001). Regression analysis demonstrated that hypertension was an independent predictor of postoperative dysphagia and cardiac events.

Conclusion: Hypertensive patients incurred a significantly greater LOS and total hospital costs than the normotensive patients. This finding is likely due to the increased incidence of postoperative complications among the hypertensive patients. In addition, hypertension significantly increased the risk of mortality among the ACF treated patients. Further research is warranted to demonstrate if optimal blood pressure control among hypertensive patients will reduce the incidence of postoperative complications and mortality following CSS.

Table 1

Table 2