Assessment of Postoperative Outcomes of Spine Fusion Patients With History of Cardiac Disease.
Journal
The Journal of the American Academy of Orthopaedic Surgeons
ISSN: 1940-5480
Titre abrégé: J Am Acad Orthop Surg
Pays: United States
ID NLM: 9417468
Informations de publication
Date de publication:
15 04 2022
15 04 2022
Historique:
received:
15
10
2021
accepted:
04
01
2022
pubmed:
18
3
2022
medline:
12
4
2022
entrez:
17
3
2022
Statut:
ppublish
Résumé
There is paucity on the effect of different cardiac diagnoses on outcomes in elective spine fusion patients. Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having a previous history of coronary artery disease (CAD), congestive heart failure (CHF), valve disorder (valve), dysrhythmia, and no heart disease (control). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, length of stay, complication outcomes, and total hospital charges among the cohort. In total, 537,252 elective spine fusion patients were stratified into five groups: CAD, CHF, valve, dysrhythmia, and control. Among the cohort, patients with CHF had significantly higher rates of morbid obesity, peripheral vascular disease, and chronic kidney disease (P < 0.001 for all). Patients with CAD had significantly higher rates of chronic obstructive pulmonary disease, diabetes, hypertension, and hyperlipidemia (all P < 0.001). Comparing postoperative outcomes for CAD and control subjects, CAD was associated with higher odds of myocardial infarction (odds ratio [OR]: 1.64 [1.27 to 2.11]) (P < 0.05). Assessing postoperative outcomes for CHF versus control subjects, patients with CHF had higher rates of pneumonia, cerebrovascular accident (CVA), myocardial infarction, sepsis, and death (P < 0.001). Compared with control subjects, CHF was a significant predictor of death in spine fusion patients (OR: 2.0 [1.1 to 3.5], P = 0.022). Patients with valve disorder compared with control displayed significantly higher rates of 30-day readmission (P < 0.05) and 1.38× greater odds of CVA by 90 days postoperatively (OR: 1.4 [1.1 to 1.7], P = 0.007). Patients with dysrhythmia were associated with significantly higher odds of CVA (OR: 1.8 [1.4 to 2.3], P < 0.001) by 30 days postoperatively. Heart disease presents an additional challenge to spine fusion patients who are undergoing a challenging and risky procedure. Before surgical intervention, a proper understanding of cardiac diagnoses could give insight into the potential risks for each patient based on their heart condition and preventive measures showing benefit in minimizing perioperative complications after elective spine fusion.
Identifiants
pubmed: 35297795
doi: 10.5435/JAAOS-D-21-00850
pii: 00124635-202204150-00012
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e683-e689Informations de copyright
Copyright © 2022 by the American Academy of Orthopaedic Surgeons.
Références
Nowbar AN, Gitto M, Howard JP, et al.: Mortality from ischemic heart disease. Circ Cardiovasc Qual Outcomes 2019;12:e005375.
Rodgers JL, Jones J, Bolleddu SI, et al.: Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis 2019;6:19.
Safiri S, Karamzad N, Singh K, et al.: Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories, 1990-2019. Eur J Prev Cardiol 2021. doi: 10.1093/eurjpc/zwab213.
doi: 10.1093/eurjpc/zwab213
Go AS, Mozaffarian D, Roger VL, et al.: American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013;127:e841.
Bovonratwet P, Bohl DD, Malpani R, et al.: Cardiac complications related to spine surgery: Timing, risk factors, and clinical effect. J Am Acad Orthop Surg 2019;27:256-263.
Passias PG, Poorman GW, Delsole E, et al.: Adverse outcomes and prediction of cardiopulmonary complications in elective spine surgery. Glob Spine J 2018;8:218-223.
Guyot JP, Cizik A, Bransford R, Bellabarba C, Lee MJ: Risk factors for cardiac complications after spine surgery. Evid Based Spine Care J 2010;1:18-25.
Lee DY, Lee SH, Jang JS: Risk factors for perioperative cardiac complications after lumbar fusion surgery. Neurol Med Chir (Tokyo) 2007;47:495-500.
Deyo RA, Hickam D, Duckart JP, Piedra M: Complications after surgery for lumbar stenosis in a veteran population. Spine (Phila Pa 1976) 2013;38:1695-1702.
Su AW, Habermann EB, Thomsen KM, Milbrandt TA, Nassr A, Larson AN: Risk factors for 30-day unplanned readmission and major perioperative complications after spine fusion surgery in adults: A review of the national surgical quality improvement program database. Spine (Phila Pa 1976) 2016;41:1523-1534.
Schoenfeld AJ, Ochoa LM, Bader JO, Belmont PJ: Risk factors for immediate postoperative complications and mortality following spine surgery: A study of 3475 patients from the national surgical quality improvement program. J Bone Joint Surg Am 2011;93:1577-1582.
Lee MJ, Hacquebord J, Varshney A, et al.: Risk factors for medical complication after lumbar spine surgery: A multivariate analysis of 767 patients. Spine (Phila Pa 1976) 2011;36:1801-1806.
Shen Y, Silverstein JC, Roth S: In-hospital complications and mor- mortality after elective spinal fusion surgery in the United States: A study of the nationwide inpatient sample from 2001-2005. J Neurosurg Anesthesiol 2009;21:21-30.
Katz AD, Mancini N, Karukonda T, Cote M, Moss IL: Comparative and predictor analysis of 30-day readmission, reoperation, and morbidity in patients undergoing multilevel ACDF versus single and multilevel ACCF using the ACS-NSQIP dataset. Spine (Phila Pa 1976) 2019;44:E1379-E1387.
Zaki O, Jain N, Yu EM, Khan SN: 30- and 90-day unplanned readmission rates, causes, and risk factors after cervical fusion: A single-institution analysis. Spine (Phila Pa 1976) 2019;44:762-769, .
Soroceanu A, Burton DC, Oren JH, et al.; International Spine Study Group: Medical complications after adult spinal deformity surgery: Incidence, risk factors, and clinical impact. Spine (Phila Pa 1976) 2016;41:1718-1723, .
Casper DS, Rihn JA: Preoperative risk stratification: Who needs medical consultation? Spine (Phila Pa 1976) 2020;45:860-861.
Wang H, Zhang Z, Qiu G, Zhang J, Shen J: Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: A retrospective study. BMC Musculoskelet Disord 2018;19:242.
Smetana GW: Preoperative pulmonary evaluation. N Engl J Med 1999;340:937-944.
Henzler D, Dembinski R, Kuhlen R, Rossaint R: Anesthetic considerations in patients with chronic pulmonary diseases. Minerva Anestesiol 2004;70:279-284.
Auerbach JD, Lenke LG, Bridwell KH, et al.: Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 2012;37:1198-1210.
Adogwa O, Lilly DT, Khalid S, et al.: Extended length of stay after lumbar spine surgery: Sick patients, postoperative complications, or practice style differences among hospitals and physicians? World Neurosurg 2019;123:e734-e739.
Ilyas H, Golubovsky JL, Chen J, Winkelman RD, Mroz TE, Steinmetz MP: Risk factors for 90-day reoperation and readmission after lumbar surgery for lumbar spinal stenosis. J Neurosurg Spine 2019;31:20-26, .
Adogwa O, Elsamadicy AA, Vuong VD, et al.: Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: A prospective single-institution experience. J Neurosurg Spine 2017;27:670-675.
Nielsen PR, Jørgensen LD, Dahl B, Pedersen T, Tønnesen H: Prehabilitation and early rehabilitation after spinal surgery: Randomized clinical trial. Clin Rehabil 2010;24:137-148.
Movahed A, Majdalany D, Gillinov M, Schiavone W: Association between myxomatous mitral valve disease and skeletal back abnormalities. J Heart Valve Dis 2017;26:564-568.
Zakai NA, Callas PW, Repp AB, Cushman M: Venous thrombosis risk assessment in medical inpatients: The medical inpatients and thrombosis (MITH) study. J Thromb Haemost 2013;11:634-641.
Spyropoulos AC, Anderson FA Jr, FitzGerald G, et al.: Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest 2011;140:706-714.
Rojas-Hernandez CM, Garcia DA: The novel oral anticoagulants. Semin Thromb Hemost 2013;39:117-126.
Sax OC, Mohamed NS, Pervaiz SS, Douglas SJ, Aboulafia AJ, Delanois RE: The effect of modern antiretroviral therapy on complication rates after total hip arthroplasty. JB JS Open Access 2021;6:e20.00175.