Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine.
Fracture fixation
Morbidity
Postoperative complications
Risk factors
Spinal fractures
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
08
11
2022
accepted:
13
11
2022
pubmed:
20
11
2022
medline:
16
2
2023
entrez:
19
11
2022
Statut:
ppublish
Résumé
Unstable thoracolumbar spinal injuries benefit from surgical fixation. However, perioperative complications significantly affect outcomes in surgicallytreated spine patients. We evaluated associations between risk factors and postoperative complications in patients surgically treated for thoracolumbar spine fractures. We conducted a retrospective multicenter study collating data from 21 spine centers across 9 countries on the treatment of AOSpine types B and C injuries of the thoracolumbar spine treated via a posterior approach. Comparative analysis was performed between patients with postoperative complications and those without. Univariate and multivariable analyses were performed. Among 535 patients, at least 1 complication occurred in 43%. The most common surgical complication was surgical-site infection (6.9%), while the most common medical complication was urinary tract infection (13.8%). Among 136 patients with American Spinal Injury Association (ASIA) Impairment Scalelevel A disability, 77.9% experienced at least 1 complication. The rate of complications also rose sharply among patients waiting >3 days for surgery (P<0.001), peaking at 68.4% among patients waiting ≥30 days. On multivariable analysis, significant predictors of complications were surgery at a governmental hospital (odds ratio = 3.38, 95% confidence interval = 1.73-6.60), having ≥1 comorbid illness (2.44, 1.61-3.70), surgery delayed due to health instability (2.56, 1.50-4.37), and ASIA Impairment Scalelevel A (3.36, 1.78-6.35), while absence of impairment (0.39, 0.22-0.71), ASIAlevel E (0.39, 0.22-0.67) and, unexpectedly, delay caused by operating room unavailability (0.60, 0.36-0.99) were protective. Types B and C thoracolumbar spine injuries are associated with a high risk of postoperative complications, especially common at governmental hospitals, and among patients with comorbidity, health instability, longer delays to surgery, and worse preoperative neurologic status.
Sections du résumé
BACKGROUND
BACKGROUND
Unstable thoracolumbar spinal injuries benefit from surgical fixation. However, perioperative complications significantly affect outcomes in surgicallytreated spine patients. We evaluated associations between risk factors and postoperative complications in patients surgically treated for thoracolumbar spine fractures.
METHODS
METHODS
We conducted a retrospective multicenter study collating data from 21 spine centers across 9 countries on the treatment of AOSpine types B and C injuries of the thoracolumbar spine treated via a posterior approach. Comparative analysis was performed between patients with postoperative complications and those without. Univariate and multivariable analyses were performed.
RESULTS
RESULTS
Among 535 patients, at least 1 complication occurred in 43%. The most common surgical complication was surgical-site infection (6.9%), while the most common medical complication was urinary tract infection (13.8%). Among 136 patients with American Spinal Injury Association (ASIA) Impairment Scalelevel A disability, 77.9% experienced at least 1 complication. The rate of complications also rose sharply among patients waiting >3 days for surgery (P<0.001), peaking at 68.4% among patients waiting ≥30 days. On multivariable analysis, significant predictors of complications were surgery at a governmental hospital (odds ratio = 3.38, 95% confidence interval = 1.73-6.60), having ≥1 comorbid illness (2.44, 1.61-3.70), surgery delayed due to health instability (2.56, 1.50-4.37), and ASIA Impairment Scalelevel A (3.36, 1.78-6.35), while absence of impairment (0.39, 0.22-0.71), ASIAlevel E (0.39, 0.22-0.67) and, unexpectedly, delay caused by operating room unavailability (0.60, 0.36-0.99) were protective.
CONCLUSIONS
CONCLUSIONS
Types B and C thoracolumbar spine injuries are associated with a high risk of postoperative complications, especially common at governmental hospitals, and among patients with comorbidity, health instability, longer delays to surgery, and worse preoperative neurologic status.
Identifiants
pubmed: 36402303
pii: S1878-8750(22)01612-6
doi: 10.1016/j.wneu.2022.11.059
pii:
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e520-e528Investigateurs
Carlos Zanardi
(C)
Nelson Picard
(N)
Maximiliano Donato
(M)
Alberto Gorgas
(A)
Efrén Peña
(E)
Óscar González
(Ó)
Sergio Mandiola
(S)
Rodrigo Remondino
(R)
Pablo Nicolas Ortiz
(PN)
José Jiménez
(J)
Jose de Jesus Gonzalez
(J)
Oscar Martinez
(O)
Pedro Reyes
(P)
Juan Jara
(J)
Julio Burgos
(J)
Martin Gagliardi
(M)
Alejandro Morales Ciancio
(AM)
Daniel Uruchi
(D)
Ricardo Martínez
(R)
Nicolás Mireles
(N)
Paulo Henrique Meira
(PH)
Nelson Astur
(N)
Robert Meves
(R)
Rian Vieira
(R)
Renan Borges
(R)
Jennyfer Chaves
(J)
Ricardo Guimaraes
(R)
Matheus Balen
(M)
Juan J Zamorano
(JJ)
Guilherme Rocha Zanini
(GR)
Germano Senna
(G)
Paulo Roberto Cabrera
(PR)
Fausto Ordoñez
(F)
FranlyArismendy Vásquez
(F)
Jefferson Daniel
(J)
Jose Carlos Veiga
(JC)
Pedro Del Santoro
(PD)
Andre Luis Sebben
(AL)
Vinicius Orso
(V)
Ricardo Penteado
(R)
Christian Pino
(C)
Esther Velarde
(E)
Charbel Jacob
(C)
Wanderson Dias
(W)
Jose Ignacio Ujhelly
(JI)
Ayelen Estay
(A)
Gustavo Noleto
(G)
Icaro de Sousa
(I)
Robson Amorim
(R)
Marlon Carneiro
(M)
Fabián Montoya
(F)
David Flórez
(D)
Raphael Augusto Corrêa
(RA)
Bastianon Santiago
(B)
Alvaro Silva Gonzalez
(AS)
Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.