Incidence of Early Complications in Cervical Spine Surgery and Relation to Preoperative Diagnosis

Abstract

Prospective observational cohort study. To determine the incidence of early postoperative complications in patients undergoing cervical spine surgery and its correlation with preoperative diagnosis. The reported incidence of complications and adverse events in cervical spine surgery is highly variable. Inconsistent definitions and varying methodologies have made the interpretation of earlier reports difficult. No large study has analyzed the overall early morbidity of cervical spine surgery in a prospective fashion or attempted to correlate preoperative diagnosis and comorbidities with perioperative complications. Data on 121 consecutive patients, who underwent cervical spine surgery at the Thomas Jefferson University Hospital from May to December 2008, was prospectively collected. Complication definition and gradations of complication severity were validated by a survey of spine surgeons and spine surgery patients. An independent assessor prospectively audited complication incidence in the patient cohort. Data on diagnosis, comorbidities, BMI, complications, and length of stay were prospectively collected and assessed using stepwise multivariate analysis. The overall incidence of early complications was 47.1% with a 40.5% incidence of minor complications and an 18.2% incidence of major complications. Major complication incidence was greater in cases of infection (20.0%) and spinal oncologic procedures (30.0%), although this difference was not of statistical significance (P=0.07). Total number of complications recorded was greater in cases of infection and neoplasm (P=0.05). Complications in cervical spine procedures occurred most frequently in cases involving trauma and spinal oncologic procedures. This study illustrates that the incidence of early complications in cervical spine procedures is greater than appreciated earlier. This difference likely arises owing to the use of a broad definition of perioperative complications, elimination of recall bias through use of a prospective assessment, and overall case complexity. Accurate assessment of the incidence of early complications in cervical spine surgery is important for patient counseling and in design of prospective quality improvement programs.