Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B
Presented by: S.Y.G. Fung
G. Liu(1), J.H. Tan(1), R.M. Ng(1), A. Seah(1), C.Z. Ng(1), L.L. Lau(1), D. Hey(1), J. Ruiz(1), J. Thambiah(1), N. Kumar(1), H.K. Wong(1)
(1) National University Health System, Orthopaedics Surgery, Singapore, Singapore
Surgical treatment of multiple cervical pathology is common. However, few studies have reported the peri-operative outcomes of cervical surgeries. The aim of this paper is to study the epidemiology, disease pattern and 90 days post-operative outcome of cervical pathologies in a multi-ethnic Asian population. To the best of the author's knowledge, this is the first study to analyze disease specific mortality rate and risk factors in a large cohort of patients with cervical pathology. Methodology: A retrospective review of all cervical surgeries was performed in a university hospital between 2001-2016. Clinical and surgical post-operative data were collected. Attention was given to identifying risk factors for surgical mortality, morbidity, worsening of neurology, prolonged hospital stay and revision surgeries using SPSS software.
Results: A total of 1010 patients were included in this study. Mean patient age was 54.6(11-86)years. 71% patients were males, 72% Chinese, 9.5% Malays and 9.2% Indians. 786(78%) patients presented with degenerative pathologies, 218(22%) had surgery resulted after trauma, 129(12.8%) had OPLL, 46(4.6%) from spinal metastasis, 8(0.8%) from infections. 64%, 35%, 0.5% patients underwent anterior, posterior and combined anterior-posterior surgeries respectively. Of anterior surgery, 71.4% were ACDF, 16.4% ACCF, 4.2% ADR. 50.3% patients had single-level anterior surgery, 29.4% had 2-level surgery and 17.6% had 3-level surgeries. Average operative time, blood loss and median hospitalization stay were 214±92.9minutes, 183±297.6ml and 5(3-90)days respectively. Of posterior surgery, 53.6% had posterior instrumentation and decompression, 45% had laminoplasty and 1.5% had posterior instrumentation. Mean posterior operative time, blood loss and median hospital stay were 222±95.5minutes, 425±462ml and 7(3-90)days respectively. 1%(0.7%MEP,0.3%SSEP) patients had intra-operative deterioration of spinal cord monitoring signal. 0.5% had post-operative neurological deterioration. 1.1%, 1.2%, 0.61% had post-operative wound infection, pneumonia and UTIs respectively. 1.2% had dura tear, 0.6% had C5 palsy and 5.5% had dysphagia, 0.2% had esophageal tear, 1.2% had postoperative airway obstruction requiring intervention. 3% had revision surgery. 165(16.3%) patients stayed in the ICU with a mean stay of 3.8days. 477(47.2%) patients stayed in SHD with a mean stay of 3.5days. Median hospitalization stay was 5(2-90) days. The overall post-cervical surgery mortality was 2.2%. Subgroup analysis shows post traumatic cervical surgery mortality was 4.1%, 0.5% for non-traumatic degenerative pathologies and 17% for spinal metastatic diseases. In univariate analysis, risk factors that were associated with mortality within a 90-day follow-up are as follows: Trauma(p=0.012) and low velocity trauma(p=0.001). Presence of metastatic spine tumours(p=0.00) and OPLL(p=0.0). Post-operative bleeding(p=0.025), infection(p=0.01) and respiratory failure(p=0.002). In multi-variate analysis, patients with spinal metastasis(OR=9.6,95%CI:2.6-35.2,p=0.001) were more likely to have a 90-day mortality, and have a longer ICU stay(OR=1.2,95%CI:1.06-1.37,p=0.005). In conclusion, cervical surgeries are safe. The mortality rates for degenerative diseases, trauma and spinal metastasis were 0.68%, 4.5% and 14.9% respectively. Patients with spinal metastasis are at higher risk for 90-day mortality and have a longer ICU stay.