1. Cardiac Complications Related to Spine Surgery: Timing, Risk Factors, and Clinical Effect
- Author
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Patawut Bovonratwet, Nathaniel T. Ondeck, Monique S. Haynes, Rohil Malpani, Daniel R. Rubio, Blake N. Shultz, Amandeep R Mahal, Jonathan N. Grauer, and Daniel D. Bohl
- Subjects
Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Time Factors ,Adolescent ,Databases, Factual ,MEDLINE ,Myocardial Infarction ,Patient Readmission ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Spine surgery ,Text mining ,Postoperative Complications ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Orthopedic Procedures ,Young adult ,Intraoperative Complications ,Perioperative Period ,Aged ,Monitoring, Physiologic ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Incidence (epidemiology) ,Incidence ,030229 sport sciences ,Perioperative ,Length of Stay ,Middle Aged ,Spine ,Heart Arrest ,Emergency medicine ,Multivariate Analysis ,Surgery ,Female ,business - Abstract
Large cohort studies evaluating cardiac complications in patients undergoing spine surgery are lacking. The purpose of this study was to determine the incidence, timing, risk factors, and effect of cardiac complications in spine surgery by using a national database, the American College of Surgeons National Surgical Quality Improvement Program.Patients who underwent spine surgery in the 2005 to 2012 National Surgical Quality Improvement Program database were identified. The primary outcome was an occurrence of cardiac arrest or myocardial infarction during the operation or the 30-day postoperative period. Risk factors for development of cardiac complications were identified using multivariate regression. The postoperative length of stay, 30-day readmission, and mortality were compared between patients who did and did not experience a cardiac complication.A total of 30,339 patients who underwent spine surgery were identified. The incidence of cardiac complications was 0.34% (95% confidence interval [CI], 0.27% to 0.40%). Of the cases in which a cardiac complication developed, 30% were diagnosed after discharge. Risk factors for the development of cardiac complications were greater age (most notably ≥80 years, relative risk [RR] = 5.53; 95% CI = 2.28 to 13.43; P0.001), insulin-dependent diabetes (RR = 2.58; 95% CI = 1.51 to 4.41; P = 0.002), preoperative anemia (RR = 2.46; 95% CI = 1.62 to 3.76; P0.001), and history of cardiac disorders and treatments (RR = 1.88; 95% CI = 1.16 to 3.07; P = 0.011). Development of a cardiac complication before discharge was associated with a greater length of stay (7.9 versus 2.6 days; P0.001), and a cardiac complication after discharge was associated with increased 30-day readmission (RR = 12.32; 95% CI = 8.17 to 18.59; P0.001). Development of a cardiac complication any time during the operation or 30-day postoperative period was associated with increased mortality (RR = 113.83; 95% CI = 58.72 to 220.68; P0.001).Perioperative cardiac complications were diagnosed in approximately 1 in 300 patients undergoing spine surgery. High-risk patients should be medically optimized and closely monitored through the perioperative period.Level III.
- Published
- 2019