317 - Adverse Outcomes and Prediction of Cardiopulmonary Complications in El...

#317 Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery

Value and Outcomes in Spine Surgery

Poster Presented by: G. Poorman

Author(s):

G. Poorman (1)
P. Passias (1)
E. Delsole (1)
C. Jalai (1)
P. Zhou (1)
S. Horn (1)
B. Beaubrun (1)
S. Vira (1)
B. Diebo (2)
V. Lafage (3)

(1) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States
(2) SUNY Downstate, Orthopaedic Surgery, Brooklyn, NY, United States
(3) Hospital for Special Surgery, New York, NY, United States

Abstract

Hypothesis: Cardiopulmonary complications non-randomly occur and are associated with specific health-related and cost sequelae. Design: Retrospective review of National Surgical Quality Improvement Program (NSQIP) years 2011-13.

Introduction: Cardiopulmonary complications are the leading cause of intraoperative mortality in elective spine patients. Understanding the risks and predictors of these sentinel events is important for risk evaluation.

Methods: Current procedural terminology coding identified elective spine surgery patients (arthrodesis, laminectomy, laminoplasty, or discectomy). 30-day incidence of myocardial infarction (MI), cardiac arrest, unplanned reintubation, on-ventilator >48 hours, pneumonia, and pulmonary embolism (PE) was estimated. Multivariate analysis for demographic and surgical predictors of complications controlled for CCI, BMI, race, sex, ASA class, fusions greater than 4 levels, and cardiopulmonary comorbidities. ANOVA t-tests analyzed outcome measures. Odds ratios reported (OR[95% CI]).

Results: Of 60,964 patients identified, incidence rates per 1,000 was 2.1 MI, 1.3 cardiac arrest, 4.3 unplanned intubation, 3.5 on-ventilator > 48 hour, 6.1 pneumonia, and 3.7 PE. The strongest surgical predictors for cardiopulmonary complications were thoracic approach (OR 3.0[1.3-4.8]) Smith-Petersen Osteotomy (OR 2.7[2.0-3.8]), and three-column osteotomy (OR 2.5[1.3-4.8]). Demographic predictors for cardiopulmonary complications were >10% weight loss within 6 months (OR 3.0[1.7-5.2]), pre-operative blood transfusion within 72 hours (OR 2.1[1.0-4.1]), and paralysis (OR 2.0[1.2-3.3]).Cardiac arrest had the highest mortality rate (34.57%), ventilator >48 hours had longest LOS (17.58 days) and lowest home discharge (35.6%).

Conclusions: Comorbidity information and surgical invasiveness were valuable predictors for cardiopulmonary complications. In light of national efforts to reduce costs and decrease hospital length of stay, the findings of this study can help administrators understand risk and appropriately allocate resources for major cardiopulmonary complications.