Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: S.Y.G. Fung

Author(s):

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

Abstract

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.