Complications after surgery for lumbar stenosis in a veteran population

Richard (Rick) Deyo, David Hickam, Jonathan P. Duckart, Mark Piedra

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Study Design. Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database. Objective. Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications. Summary of Background Data. Surgery for spinal stenosis is concentrated among older adults, in whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer studies have focused on major cardiopulmonary complications, using prospectively collected data. Methods. We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the Veterans Affairs National Surgical Quality Improvement Program database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Results. Among 12,154 eligible patients, major medical complications occurred in 2.1%, wound complications in 3.2%, and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, long-term corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than with decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (odds ratio for ASA class 4 vs . class 1 or 2: 2.97; 95% confidence interval, 1.68-5.25; P = 0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than were decompressions alone (odds ratio = 2.85; 95% confidence interval, 2.14-3.78; P <0.0001). Conclusion. ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety.

Original languageEnglish (US)
Pages (from-to)1695-1702
Number of pages8
JournalSpine
Volume38
Issue number19
DOIs
StatePublished - Sep 1 2013

Fingerprint

Veterans
Pathologic Constriction
Population
Quality Improvement
Decompression
Adrenal Cortex Hormones
Wounds and Injuries
Odds Ratio
Databases
Confidence Intervals
Insulin
Spinal Stenosis
Mortality
Patient Safety
Coma
Heart Arrest
Pulmonary Embolism
Comorbidity
Sepsis
Pneumonia

Keywords

  • Complications
  • Lumbar fusion
  • Lumbar stenosis
  • Patient safety
  • Postoperative mortality
  • Prediction rule
  • Receiver operating characteristic (ROC)
  • Risk prediction
  • Spinal stenosis
  • Surgical complications

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Complications after surgery for lumbar stenosis in a veteran population. / Deyo, Richard (Rick); Hickam, David; Duckart, Jonathan P.; Piedra, Mark.

In: Spine, Vol. 38, No. 19, 01.09.2013, p. 1695-1702.

Research output: Contribution to journalArticle

Deyo, Richard (Rick) ; Hickam, David ; Duckart, Jonathan P. ; Piedra, Mark. / Complications after surgery for lumbar stenosis in a veteran population. In: Spine. 2013 ; Vol. 38, No. 19. pp. 1695-1702.
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abstract = "Study Design. Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database. Objective. Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications. Summary of Background Data. Surgery for spinal stenosis is concentrated among older adults, in whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer studies have focused on major cardiopulmonary complications, using prospectively collected data. Methods. We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the Veterans Affairs National Surgical Quality Improvement Program database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Results. Among 12,154 eligible patients, major medical complications occurred in 2.1{\%}, wound complications in 3.2{\%}, and 90-day mortality in 0.6{\%}. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, long-term corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than with decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (odds ratio for ASA class 4 vs . class 1 or 2: 2.97; 95{\%} confidence interval, 1.68-5.25; P = 0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than were decompressions alone (odds ratio = 2.85; 95{\%} confidence interval, 2.14-3.78; P <0.0001). Conclusion. ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety.",
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T1 - Complications after surgery for lumbar stenosis in a veteran population

AU - Deyo, Richard (Rick)

AU - Hickam, David

AU - Duckart, Jonathan P.

AU - Piedra, Mark

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N2 - Study Design. Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database. Objective. Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications. Summary of Background Data. Surgery for spinal stenosis is concentrated among older adults, in whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer studies have focused on major cardiopulmonary complications, using prospectively collected data. Methods. We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the Veterans Affairs National Surgical Quality Improvement Program database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Results. Among 12,154 eligible patients, major medical complications occurred in 2.1%, wound complications in 3.2%, and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, long-term corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than with decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (odds ratio for ASA class 4 vs . class 1 or 2: 2.97; 95% confidence interval, 1.68-5.25; P = 0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than were decompressions alone (odds ratio = 2.85; 95% confidence interval, 2.14-3.78; P <0.0001). Conclusion. ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety.

AB - Study Design. Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database. Objective. Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications. Summary of Background Data. Surgery for spinal stenosis is concentrated among older adults, in whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer studies have focused on major cardiopulmonary complications, using prospectively collected data. Methods. We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the Veterans Affairs National Surgical Quality Improvement Program database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Results. Among 12,154 eligible patients, major medical complications occurred in 2.1%, wound complications in 3.2%, and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, long-term corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than with decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (odds ratio for ASA class 4 vs . class 1 or 2: 2.97; 95% confidence interval, 1.68-5.25; P = 0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than were decompressions alone (odds ratio = 2.85; 95% confidence interval, 2.14-3.78; P <0.0001). Conclusion. ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety.

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KW - Lumbar stenosis

KW - Patient safety

KW - Postoperative mortality

KW - Prediction rule

KW - Receiver operating characteristic (ROC)

KW - Risk prediction

KW - Spinal stenosis

KW - Surgical complications

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