42 - Cerebral Vascular Accidents following Lumbar Spine Fusion Surgery...

#42 Cerebral Vascular Accidents following Lumbar Spine Fusion 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: A lumbar fusion (LF) is an effective surgical procedure to treat lumbar degenerative pathology. Although rare, major neurological complications including cerebral vascular accidents (CVA) can be catastrophic. To demonstrate the impact of a post-operative CVA, a large population-based database was analyzed to specify the incidence, risk factors, hospital resource utilization and early post-operative outcomes following a complicated lumbar spinal fusion.

Methods: The Nationwide Inpatient Sample (NIS) database was queried from 2002-2011. Patients undergoing an elective anterior lumbar fusion (ALF), posterior lumbar fusion (PLF), or combined anterior-posterior fusion (APLF) for a degenerative condition were selected. Patients with a documented post-operative CVA were identified. Patient demographics, Charlson Co-morbidity Index (CCI), length of stay (LOS), costs, and mortality were assessed. SPSS v.20 was utilized for statistical analysis with independent T-tests for continuous variables and χ2-tests for categorical data. Binomial logistic regression was utilized to identify significant risk factors of a CVA. An alpha value of p ≤0.001 denoted a statistical significance.

Results: A total of 264,891 LFs were identified between 2002-2011 of which 340 (1.3 per 1,000) developed a post-operative CVA. Patients experiencing a post-operative CVA were significantly older (64.4 vs 55.0, p< 0.001) and had a greater comorbidity burden (CCI) than unaffected patients (4.03 vs 2.51, p< 0.001). In addition, patients in the CVA cohort more often underwent 3+ level fusions and deformity corrections (p< 0.001). Furthermore, regression analysis demonstrated that age >65 years and a history of neurologic disorders, paralysis, liver disease, congestive heart failure (CHF), or electrolyte imbalance were significant risk factors for a post-operative CVA. Lastly, the CVA cohort was associated with a significantly greater LOS (8.9 vs 3.8 days, p< 0.001), total hospital costs ($41,454 vs $25,885, p< 0.001), and mortality (73.7 vs 0.8 per 1,000 cases, p< 0.001) than the unaffected patients.

Conclusion: A postoperative CVA following a LF procedure is associated with worsened patient outcomes and greater hospital resource utilization. Older patients with a history of CHF, neurologic disorders, or electrolyte imbalance were at a significantly increased risk for developing a CVA. The risk of mortality from a CVA following lumbar fusion surgery is exponential. Further studies are warranted to characterize and identify pre-operative risks in order to mitigate these catastrophic events from occurring.