Oral Posters: Values and Outcomes in Spine Surgery

Presented by: S. Yi - View Audio/Video Presentation (Members Only)

Author(s):

S. Yi(1), D. Kim(1), D.H. Chun(1), D.A. Shin(1), Y. Ha(1), K.N. Kim(1), D.H. Yoon(1)

(1) Spine and Spinal Cord Institute,Yonsei University, College of Medicine, Neurosurgery, Seoul, Korea, Republic of

Abstract

Objective: Degenerative spine disease has been increasing in accordance with the aging society, there is an increasing elderly patients receiving spinal surgery. Many elderly patients have high surgical risk because of comorbidity and poor general conditions. However, surgical risk assessment tool for spinal surgery has not been developed. This study is aimed to evaluate the feasibility of Estimation of Physiological Ability and Surgical Stress (E-PASS) and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems in patients with spinal surgical procedures.

Methods: We restropectively reviewed 877 patients who had undergone spinal surgery from January 2015 to June 2015 at single tertiary care center in the department of neurosurgery. We investigate complications within one month after surgery. The E-PASS system is composed of preoperative risk score, surgical stress score and comprehensive risk score that is calculated from both preoperative risk score and surgical stress score. The parameters of preoperative risk score are age, severe heart disease, severe pulmonary disease, diabetes mellitus, performance status index and ASA classification. The parameters of surgical stress score are blood loss, body weight, operative time and extent of skin incision. Criteria of skin incision in the E-PASS was modified to fit the spine surgery as follows: 0 as minor incision up to 2 level partial hemilaminectomy, 1 as moderate incision up to 2 level fusion and 2 as over 3 level fusion. The POSSUM system is composed of physiological score that is consisted of age, cardiac signs, respiratory history, systolic blood pressure, pulse rate, GCS score, hemoglobin, white blood cell count, serum urea, serum sodium, serum potassium and electrocardiogram, and surgical stress score that is consisted of op severity, no. of reoperation, blood loss, peritoneal soiling, malignancy and urgency of operation. We calculated the E-PASS and POSSUM scores for enrolled patients and investigated the relationship between postoperative complications and both surgical risk scoring systems.

Results: Over all complication rate of spinal surgery was 3.6%. Total 32 patients have postoperative complications; 7 patients had postoperative hematoma, 6 had complications related instrumentation, 5 had wound infection, 5 had wound dehiscence, 4 had CSF leakage and 1 had pneumonia. 8 patients had undergone revision surgery because of postoperative complications. All POSSUM scores (p< 0.004) and the preoperative risk score and the comprehensive risk score of E-PASS system (p< 0.001) were significantly higher in patients with postoperative complications than in those without postoperative complications. The area under the receiver operating characteristic curve for the predicted postoperative complications after spine surgery was 0.766 for the E-PASS and 0.726 for the POSSUM system.

Conclusion: E-PASS and POSSUM system can be useful for estimating the postoperative surgical risk in patients undergone spine surgery. Further studies of postoperative risk assessment specified to spinal surgery are needed.