178. All-cause mortality following cervical and thoracolumbar adult deformity surgery: incidence and causes

Abstract

<h3>BACKGROUND CONTEXT</h3> Both cervical and thoracolumbar deformity surgeries are often complex and invasive, with a fairly comorbid patient population. However, few studies have assessed the mortality rates, frailty, and invasiveness between the two populations. <h3>PURPOSE</h3> The aim of this study was to determine the incidence density of all-cause mortality as well as the 30-day and 90-day mortality rates. Secondary objectives were to ascertain causes of death, frailty of patients, and invasiveness of surgeries. We hypothesize that the mortality rates and causes of death associated with cervical deformity surgery will be higher than those for thoracolumbar deformity surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> A total of 146 cervical deformity and 1,380 thoracolumbar patients were included. <h3>OUTCOME MEASURES</h3> Outcomes included: mortality incidence density, 30- and 90-day mortality rates. <h3>METHODS</h3> Using two prospective, multicenter databases, we identified cervical and thoracolumbar deformity patients. Clinical parameters, surgical parameters and all-cause mortality were analyzed. Incidence density was calculated based on the equation: 100 × (number of deaths)/(sum of total years of follow-up for all patients). <h3>RESULTS</h3> DB1-CD: Death was reported for 23 patients (15.7%). Mean age 61.43 ± 10.45, 34% of individuals frail (CD-FI) and mean invasiveness (CD-SR) was 79 ± 96. The mean time to death 25.46 ± 18.86 months. The mortality incidence density 8.75 deaths/year/1,000 patients. The 30-day mortality rate was 0.68% (1/146), 90-day mortality rate 1.3% (2/146). The three most common causes of death: pneumonia (9.68%), congestive heart failure (6.45%) and myocardial infarction (6.45%). DB2-TL: death was reported for 38 patients (2.75%). Mean age 60.5 ± 14.24, 58% of individuals frail (ASD-FI), and mean invasiveness (ASD-SR) 92.7±34.7. Mean time to death 29.68 ± 20.26 months. Average follow-up 1.82 ± 1.5 years. The mortality incidence density was 1.5 deaths/year/1,000 patients. The 30-day mortality ratewas 072% (1/1,380) and 90-day mortality rate 0.22% (3/1,380). The three most common causes of death: pneumonia (13.16%), myocardial infarction (10.53%) and malignancy (7.89%). There were no intraoperative deaths. <h3>CONCLUSIONS</h3> Cervical deformity patients had significantly more deaths per year (8.75 cervical vs 1.5 thoracolumbar) per 1,000 patients than thoracolumbar deformity surgeries. Pneumonia and myocardial infarction were common causes of death in both cervical and thoracolumbar deformity surgery patients. No deaths occurred during surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.