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Abstract
BackgroundRelatively few studies have focused on the major medical complications that are more common in older adults. Furthermore, these studies have generally not reported how accurately a risk factor, or combination of risk factors, can distinguish between those who will have a complication and those who will not.MethodsA total of 236 consecutive patients who had undergone surgical treatment for degenerative lumbar scoliosis between June 2008 and June 2012 were included retrospectively in this study. The demographic distribution, medical history, and clinical data were collected to investigate the predictive factors of postoperative complications by logistic regression.ResultsAmong 236 eligible patients, major medical complications occurred in 7.2% of cases and wound complications occurred in 1.7% of cases. Ninety-day mortality rate was 0.4%. Postoperative complications were strongly associated with history of severe chronic obstructive pulmonary disease (COPD) (P = 0.031), dyspnea with minimal exertion (P = 0.041), being at least partially dependent (P = 0.041), smoking within the past year (P = 0.044), American Society of Anesthesiologists (ASA) class of more than 2 (P = 0.000), diabetes treated with insulin (P = 0.003), and steroid use for chronic condition (P = 0.003). In logistic regressions, operation time (odds ratio 2.45, 95% confidence interval 1.11–4.78), ASA class (class 3 or 4 vs. class 1 or 2: odds ratio 2.21, 95% confidence interval 1.22–3.45), insulin-dependent diabetes (odds ratio 1.72, 95% confidence interval 1.18–2.43), and steroid use for chronic condition (odds ratio 1.55, 95% confidence interval 1.06–2.32) may be reasonable predictors for an individual's likelihood of surgical complications.ConclusionsThe occurrence of postoperative complications is most likely multifactorial and is related to operation time, ASA class, insulin-dependent diabetes and steroid use for chronic condition.
Highlights
The identification and quantification of risk factors for postoperative complication after spine surgery are of paramount importance to the patient and the clinician
Of the 21 patients identified as having postoperative complications, 10 had history of severe chronic obstructive pulmonary disease (COPD) (47.6%), 5 had dyspnea with minimal exertion (23.8%), 7 were at least partially dependent (33.3%), 12 were smoking within the past year (57.1%), 18 had American Society of Anesthesiologists (ASA) class
Of the patients in the control group, 20 had history of severe COPD (23.8%), 6 had dyspnea with minimal exertion (7.1%), 10 were at least partially dependent (11.9%), 28 were smoking within the past year (33.3%), 31 had ASA class of more than 2 (36.9%), 26 had diabetes treated with insulin (31.0%), and 20 had steroid use for chronic condition (23.8%)
Summary
The identification and quantification of risk factors for postoperative complication after spine surgery are of paramount importance to the patient and the clinician. This concern is especially important among older patients, in whom complications are more common than among younger adults. In addition to its obvious importance for patient safety, risk factor information becomes critical as Degenerative lumbar scoliosis is a common diagnosis prompting spine surgery in older adults, and surgical rates have increased in this population [1]. Few studies have focused on the major medical complications that are more common in older adults These studies have generally not reported how accurately a risk factor, or combination of risk factors, can distinguish between those who will have a complication and those who will not
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