A scoring system to predict postoperative medical complications in high-risk patients undergoing elective thoracic and lumbar arthrodesis

Jacqueline L. Munch, Natalie L. Zusman, Elizabeth G. Lieberman, Ryland S. Stucke, Courtney Bell, Travis C. Philipp, Sawyer Smith, Alexander Ching, Robert A. Hart, Jung U. Yoo

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background Context: Various surgical factors affect the incidence of postoperative medical complications following elective spinal arthrodesis. Because of the inter-relatedness of these factors, it is difficult for clinicians to accurately risk-stratify individual patients. Purpose: Our goal was to develop a scoring system that predicts the rate of major medical complications in patients with significant preoperative medical comorbidities, as a function of the four perioperative parameters that are most closely associated with the invasiveness of the surgical intervention. Study Design/Setting: This study used level 2, Prognostic Retrospective Study. Patient Sample: The patient sample consisted of 281 patients with American Society of Anesthesiologists (ASA) scores of 3-4 who underwent elective thoracic, lumbar, or thoracolumbar fusion surgeries from 2007 to 2011. Outcome Measures: Physiologic risk factors, number of levels fused, complications, operative time, intraoperative fluids, and estimate blood loss were the outcome measures of this study. Methods: Risk factors were recorded, and patients who suffered major medical complications within the 30-day postoperative period were identified. We used chi-square tests to identify factors that affect the medical complication rate. These factors were ranked and scored by quartiles. The quartile scores were combined to form a single composite score. We determined the major medical complication rate for each composite score, and divided the cohort into quartiles again based on score. A Pearson linear regression analysis was used to compare the incidence of complications to the score. Results: The number of fused levels, operative time, volume of intraoperative fluids, and estimated blood loss influenced the complication rate of patients with ASA scores of 3-4. The quartile ranking of each of the four predictive factors was added, and the sum became the composite score. This score predicted the complication rate in a linear fashion ranging from 7.6% for the lowest risk group to 34.7% for the highest group (r=0.998, p

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - Jan 9 2015

Keywords

  • Complications
  • High-risk
  • Lumbar fusion
  • Outcomes
  • Scoring
  • Thoracolumbar arthrodesis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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    Munch, J. L., Zusman, N. L., Lieberman, E. G., Stucke, R. S., Bell, C., Philipp, T. C., Smith, S., Ching, A., Hart, R. A., & Yoo, J. U. (Accepted/In press). A scoring system to predict postoperative medical complications in high-risk patients undergoing elective thoracic and lumbar arthrodesis. Spine Journal. https://doi.org/10.1016/j.spinee.2015.07.442