Farshad M, et al. - The researchers aimed to identify predictive risk factors for peri- and early post-operative morbidities in spine surgeries of different complexities in a large cohort of consecutive patients. For peri- and early post-operative morbidities in spine surgery, several modifiable and non-modifiable risk factors were recognized. Among these, surgical factors [complexity, revision surgery, instrumentation (including the pelvis etc)] seemed to play a crucial role. They proposed and validated a classification of surgical complexity.

Methods

• Researchers performed a retrospective case study.
• They created and applied a classification of surgical complexity (grade I-III) to 1,009 patients who consecutively underwent spine surgery at a single university hospital.
• Documentation of the incidence and type of peri- and early post-operative morbidities was performed.
• Risk factors were analyzed with multivariate binary logistic regression for
• Hospital stay≥10 days,
• Intermediate care unit (IMC) stay≥24 hours,
• Blood loss>500mL, and
• Occurrence of a surgical or medical morbidity.

Results

• In this study, morbidity was defined as a deviation from the regular postoperative course; this included surgical reasons such as relapse of symptoms of any kind (3.3%), wound healing problems (2.4%), implant-associated complications (1.6%), post-operative neurological deficits (1.5%), infection (1.5%), fracture (0.8%), and dural tear in need of revision (0.6%).
• Among others, medical reasons included anemia (1.8%), symptomatic electrolyte derailment (1.0%), and cardiac complications (0.7%).
• Male gender was identified as an independent risk factor associated with a surgical reason for an irregular post-operative course.
• Risk factors for a medical reason included high creatinine levels preoperatively, higher blood loss, and systemic steroid use.
• Preoperatively high CRP, prolonged postoperative IMC stay, and revision surgery were the independent risk factors for a prolonged hospitalization.
• A blood loss>500mL was observed in association with spinal stabilization/fusion surgery, particularly if involving the lumbosacral spine, age, and length of surgery.
• Higher surgical complexity, involvement of the pelvis in instrumentation, ASA class≥3, and higher creatinine levels preoperatively were observed to be associated with a postoperative IMC stay>24 hours.