353 - Peri-operative Characteristics, Outcomes, and Risks of Post-operative...

#353 Peri-operative Characteristics, Outcomes, and Risks of Post-operative Complications in Patients with Anemia Following Cervical Spinal Surgery

Cervical Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

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

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

Abstract

Introduction: Preoperative anemia is a prevalent comorbidity in patients undergoing cervical spinal intervention for degenerative conditions. A population-based database was analyzed to characterize patients with anemia in terms of the demographics, hospital course, costs, and mortality associated with cervical spine surgery.

Methods: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002-2011. Patients who underwent an anterior cervical fusion (ACF), posterior cervical fusion (PCF), or posterior cervical decompression (PCD) for cervical degenerative pathology were identified and separated into cohorts. Incidences of preoperative anemia were identified in each cohort. Patient demographics, comorbidities (CCI), length of stay (LOS), costs, early postoperative outcomes, and mortality were assessed. SPSS v.20 was utilized for statistical analysis with Student´s T-test for discrete variables and χ2-test for categorical data. A p-value of < 0.001 denoted significance. Multivariate logistic regression with a 95% confidence interval was utilized to assess for the risk of early postoperative complications in patients with anemia after controlling for demographics, comorbidities, and hospital variables.

Results: A total of 314,447 cervical spinal cases were identified in the NIS of which 260,402 (82.8%) were ACFs, 24,919 (8%) were PCFs, and 9% were PCDs. A preoperative diagnosis of anemia was demonstrated in 2.3%, 8.2%, and 4.4% of patients in the ACF, PCF, and PCD cohorts respectively. In all cohorts, patients with anemia were significantly older and demonstrated a greater comorbidity burden than the non-anemic patients (p< 0.001). In addition, regardless of the surgical approach, anemic patients incurred a longer hospitalization and greater total hospital costs (p< 0.001). Furthermore, mortality was significantly greater among patients with anemia. In all surgical cohorts, anemic patients demonstrated a significantly greater incidence of postoperative pulmonary embolism (PE), deep vein thrombosis (DVT), cardiac events, urinary tract infections (UTI), and aspiration (p< 0.001). Lastly, the regression analysis demonstrated that anemic patients are associated with a greater risk for postoperative DVT, wound infection, neurological events, UTI and dysphagia.

Conclusion: This national study demonstrated that regardless of the surgical approach, patients with anemia incurred a greater LOS and hospital costs than the non-anemic patients after cervical spine surgery. These findings are likely explained by an older and more comorbid patient population and the greater incidence of postoperative complications in the anemia cohorts. Regression analysis demonstrated that preoperative anemia significantly increased the risk for developing a postoperative DVT, wound infection, UTI, dysphagia, and neurological complications after cervical spine surgery. Further studies are warranted to delineate this association between anemia and its implications on the postoperative outcomes and mortality.