PT  - JOURNAL ARTICLE
AU  - KAYE, I. DAVID
AU  - WAGNER, SCOTT C.
AU  - BUTLER, JOSEPH S.
AU  - SEBASTIAN, ARJUN
AU  - MORRISSEY, PATRICK B.
AU  - KEPLER, CHRISTOPHER
TI  - Risk Factors for Adverse Cardiac Events After Lumbar Spine Fusion
AID  - 10.14444/5079
DP  - 2018 Oct 01
TA  - International Journal of Spine Surgery
PG  - 638--643
VI  - 12
IP  - 5
4099  - https://www.ijssurgery.com/content/12/5/638.short
4100  - https://www.ijssurgery.com/content/12/5/638.full
SO  - Int J Spine Surg2018 Oct 01; 12
AB  - Background: To determine the incidence and risk factors for adverse cardiac events after lumbar spine fusion.Methods: A total of 50 495 patients were identified through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent lumbar spine fusion between 2005 and 2015. The 30-day postoperative data were analyzed to assess for the incidence of adverse cardiac events including cardiac arrest or myocardial infarction. Of those who experienced an event, patient- and surgery-specific parameters were evaluated to assess for risk factors.Results: A total of 240 cardiac events occurred in the studied cohort (4.76 events/1000 patients). Factors that were associated with an increased cardiac risk were age (odds ratio [OR] = 1.039, 95% confidence interval [CI] = 1.03, 1.05, P < .001), male sex (OR = 1.51, 95% CI = 1.17, 1.94, P = .001), insulin-dependent diabetes (OR = 1.83, 95% CI = 1.29, 2.6, P = .001), American Society of Anesthesiologists (ASA) score >3 (OR = 1.92, 95% CI = 1.00, 3.65, P = .048), absolute hematocrit different from 45 (OR = 1.07, 95% CI = 1.04, 1.10, P < .001), and smoking (OR = 1.39, 95% CI = 1.02, 1.90, P = .04). The impact of sustaining a cardiac event in the setting of single-level lumbar fusion is catastrophic as the 30-day postoperative mortality rate for those sustaining an event was 24.6% (59/240 patients), compared to 0.2% (87/50 255) for those not sustaining an event (P < .001). Conclusions: Cardiac events after lumbar fusion are a rare but devastating series of complications. Several risk factors were identified, including insulin-dependent diabetes mellitus, smoking, advanced age, male sex, ASA score of >3, and anemia/polycythemia. Considering the severity of these consequences, appropriate risk stratification is imperative, and optimization of modifiable risk factors may mitigate this risk.