Risk factors for cardiac complications after spine surgery

 

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ABSTRACT

Study design: Registry study using prospectively collected data

Objective: To determine risk factors for cardiac complications in spine surgery.

Methods: The Spine End Results Registry 2003–2004 is an exhaustive database of 1,592 patients who underwent spine surgery at the University of Washington Medical Center or Harborview Medical Center. Detailed information regarding patient demographic, medical comorbidity, surgical invasiveness and adverse outcomes were prospectively recorded. The primary outcome of measure was the occurrence of a cardiac complication in the perioperative period. Relative risk (RR) and 95 % confidence intervals were calculated for each of the categorical variables. Multiple log-binomial regression analysis was performed to investigate the independent factors associated with cardiac complication.

Results: The incidence of cardiac complication after spine surgery was 6.7 %. There were 136 cardiac complications in 107 patients after spine surgery. Age, diabetes, previous cardiac history, elevated adjusted Charlson comorbidity score, revision surgery, combined anterior-posterior approaches, and surgical invasiveness were statistically significant risk factors for cardiac complication after spine surgery.

Conclusions: The results of the present study suggest numerous statistically significant risk factors for cardiac complications after spine surgery. These results may aid the clinician with preoperative risk stratification and patient counseling.

STUDY RATIONALE Numerous studies have examined the morbidity and mortality of spine surgery 1 2 3 4 5 6 7 8 9, however, there is a paucity of literature examining the occurrence of cardiac complications after spine surgery. Cardiac complications are a leading cause of death after non-cardiac surgery 4 5 10. Lee et al reported a 0.8 % incidence of cardiac complications after lumbar fusion in retrospective review of 901 patients 11, but identification of statistically significant risk factors was limited by the study methodology. OBJECTIVE The objective of this study is to identify risk factors for cardiac complications after spine surgery.

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EDITORIAL STAFF PERSPECTIVES

This study touches upon a type of complication frequently overlooked in spine surgery. Cardiac and other internal medical complications are commonly assumed to be covered by other specialties, such as Anesthesia or Medical specialties and are therefore overlooked by surgical specialties such as ours. However, as this study shows, subspecialties such as Spine have very specific concerns, which are not specifically addressed by anyone but us.

Possible short comings of this study concern lack of control of variables typical for a retrospective study such as this. For cardiac conditions this may include perioperative beta-blockade or absence thereof, use of chemical thrombembolism prophylaxis and utilization of Intensive Care facilities for at-risk patients. The value of this study however lies in this cohort size and diversity of conditions treated. It may direct us to utilize preoperative medicine consult services to optimize preoperative preparations for at-risk patients and may help us counsel patients more honestly.