77. Perioperative outcomes of concomitant shoulder diagnoses for patients undergoing cervical spine procedures

Abstract

<h3>BACKGROUND CONTEXT</h3> For patients undergoing a cervical spine procedure, the effect of a shoulder injury on perioperative outcomes is not well understood. Our study aimed to investigate the impact shoulder injuries have on perioperative outcomes for elective cervical spine surgery patients. <h3>PURPOSE</h3> To evaluate the effect of concomitant shoulder injuries on perioperative outcomes of elective cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of a national patient database between 2007-2017. <h3>PATIENT SAMPLE</h3> A total of 1,482,311 elective cervical spine surgery patients. <h3>OUTCOME MEASURES</h3> Comorbidity burden, invasiveness, perioperative complications, length of stay (LOS), total hospital charges. <h3>METHODS</h3> Patients undergoing elective cervical spine surgery were isolated with ICD-9 diagnosis codes. Cervical procedure (CP) patients with concurrent shoulder diagnosis(S-Dx) were further isolated. Means comparison tests compared differences in demographics, surgical, and perioperative outcomes between those who had a cervical procedure and a concurrent shoulder diagnosis (CP/S-Dx) and those who had a cervical procedure with no shoulder diagnosis (CP). Logistic regression analysis assessed the odds of complication associated with a shoulder diagnosis, controlling for age and surgical invasiveness. <h3>RESULTS</h3> 1,482,311 elective cervical spine surgery patients were included. Overall, 17,873(1.2%) patients underwent a CP and had a concurrent S-Dx. CP and S-Dx patients compared to only CP patients were significantly younger and male (both p<0.05). CP/ S-Dx patients presented with higher rates of alcohol abuse, anemia, rheumatoid arthritis, congestive heart failure, chronic pulmonary disease, drug abuse, hypertension, and liver disease (all p <0.05). CP/S-Dx patients underwent more invasive procedures (p<0.001) including spinal fusions and osteotomies (both p<0.05) but less decompressions (p<0.001). CP/S-Dx patients had higher overall perioperative complication rates, including higher rates of anemia, cardiac, respiratory, DVT and experienced a longer LOS (5.97 days vs 3.71 days) (all p<0.05). CP/S-Dx patients had higher rates of nonhome discharge (36.7% vs 25.8%) and incurred greater total hospital charges ($101,899 vs $73,572; both p<0.001). Adjusting for age and invasiveness, patients undergoing a cervical procedure with a shoulder diagnosis were associated with increased odds of any complication (OR:1.3[1.3-1.4]; p<0.001). <h3>CONCLUSIONS</h3> Patients with a concurrent shoulder diagnosis undergoing a cervical spine procedure were 30% more likely to experience a perioperative complication compared to those without a shoulder injury. Prior to proceeding with surgery, providers should consider the effect of shoulder injuries on outcomes of cervical spine procedures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.