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Objective Intradural spinal tumors are uncommon and while associations between clinical characteristics and surgical outcomes have been explored, there remains a paucity of literature unifying diverse predictors into an integrated risk model. To predict postresection outcomes for patients with spinal tumors. Methods IBM MarketScan Claims Database was queried for adult patients receiving surgery for intradural tumors between 2007 and 2016. Primary outcomes-of-interest were nonhome discharge and 90-day postdischarge readmissions. Secondary outcomes included hospitalization duration and postoperative complications. Risk modeling was developed using a regularized logistic regression framework (LASSO, least absolute shrinkage and selection operator) and validated in a withheld subset. Results A total of 5,060 adult patients were included. Most surgeries utilized a posterior approach (n=5,023, 99.3%) and tumors were most commonly found in the thoracic region (n=1,941, 38.4%), followed by the lumbar (n=1,781, 35.2%) and cervical (n=1,294, 25.6%) regions. Compared to models using only tumor-specific or patient-specific features, our integrated models demonstrated better discrimination (area under the curve [AUC] [nonhome discharge] = 0.786; AUC [90-day readmissions] = 0.693) and accuracy (Brier score [nonhome discharge] = 0.155; Brier score [90-day readmissions] = 0.093). Compared to those predicted to be lowest risk, patients predicted to be highest-risk for nonhome discharge required continued care 16.3 times more frequently (64.5% vs. 3.9%). Similarly, patients predicted to be at highest risk for postdischarge readmissions were readmitted 7.3 times as often as those predicted to be at lowest risk (32.6% vs. 4.4%). Conclusion Using a diverse set of clinical characteristics spanning tumor-, patient-, and hospitalization-derived data, we developed and validated risk models integrating diverse clinical data for predicting nonhome discharge and postdischarge readmissions. [ABSTRACT FROM AUTHOR]

To compare complications, readmissions, revisions, and payments between navigated and conventional pedicle screw fixation for treatment of spine deformity. The Thomson Reuters MarketScan national longitudinal database was used to identify patients undergoing osteotomy, posterior instrumentation, and fusion for treatment of spinal deformity with or without image-guided navigation between 2007-2016. Conventional and navigated groups were propensity-matched (1:1) to normalize differences between demographics, comorbidities, and surgical characteristics. Clinical outcomes and charges were compared between matched groups using bivariate analyses. A total of 4,604 patients were identified as having undergone deformity correction, of which 286 (6.2%) were navigated. Propensity-matching resulted in a total of 572 well-matched patients for subsequent analyses, of which half were navigated. Rate of mechanical instrumentation-related complications was found to be significantly lower for navigated procedures (p = 0.0371). Navigation was also associated with lower rates of 90-day unplanned readmissions (p = 0.0295), as well as 30- and 90-day postoperative revisions (30-day: p = 0.0304, 90-day: p = 0.0059). Hospital, physician, and total payments favored the conventional group for initial admission (p = 0.0481, 0.0001, 0.0019, respectively); however, when taking into account costs of readmissions, hospital payments became insignificantly different between the two groups. Procedures involving image-guided navigation resulted in decreased instrumentation-related complications, unplanned readmissions, and postoperative revisions, highlighting its potential utility for the treatment of spine deformity. Future advances in navigation technologies and methodologies can continue to improve clinical outcomes, decrease costs, and facilitate widespread adoption of navigation for deformity correction. [ABSTRACT FROM AUTHOR]

Background: Postoperative metrics are increasingly important in determining standards of quality for physicians and hospitals. Although complications following spinal surgery have been described, procedural and patient variables have yet to be incorporated into a predictive model of adverse-event occurrence. We sought to develop a predictive model of complication occurrence after spine surgery.Methods: We used longitudinal prospective data from a national claims database and developed a predictive model incorporating complication type and frequency of occurrence following spine surgery procedures. We structured our model to assess the impact of features such as preoperative diagnosis, patient comorbidities, location in the spine, anterior versus posterior approach, whether fusion had been performed, whether instrumentation had been used, number of levels, and use of bone morphogenetic protein (BMP). We assessed a variety of adverse events. Prediction models were built using logistic regression with additive main effects and logistic regression with main effects as well as all 2 and 3-factor interactions. Least absolute shrinkage and selection operator (LASSO) regularization was used to select features. Competing approaches included boosted additive trees and the classification and regression trees (CART) algorithm. The final prediction performance was evaluated by estimating the area under a receiver operating characteristic curve (AUC) as predictions were applied to independent validation data and compared with the Charlson comorbidity score.Results: The model was developed from 279,135 records of patients with a minimum duration of follow-up of 30 days. Preliminary assessment showed an adverse-event rate of 13.95%, well within norms reported in the literature. We used the first 80% of the records for training (to predict adverse events) and the remaining 20% of the records for validation. There was remarkable similarity among methods, with an AUC of 0.70 for predicting the occurrence of adverse events. The AUC using the Charlson comorbidity score was 0.61. The described model was more accurate than Charlson scoring (p < 0.01).Conclusions: We present a modeling effort based on administrative claims data that predicts the occurrence of complications after spine surgery.Clinical Relevance: We believe that the development of a predictive modeling tool illustrating the risk of complication occurrence after spine surgery will aid in patient counseling and improve the accuracy of risk modeling strategies. [ABSTRACT FROM AUTHOR]

COMMENTARY ON: Gire JD, Roberto RF, Bobinski M, et al. The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. Spine J 2013;13:510–9 (in this issue). [Copyright &y& Elsevier]

The 6-minute walking test (6WT) has been previously shown to be a reliable and valid outcome measure. It is unclear if the 6WT may further help to detect differences in well performing patients that reach a ceiling effect in PROMs after surgery. To evaluate changes and timing of change in objective functional impairment (OFI) as measured with the smartphone-based 6WT in relation to patient-reported outcome measures (PROMs) after surgery for degenerative lumbar disorders (DLD). Prospective observational cohort study. Fifty consecutive patients undergoing surgery for DLD. Patients self-determined their OFI using the 6WT application (6WT-app) and completed a set of paper-based PROMs before, 6 weeks and 3 months after surgery. Fifty patients undergoing surgery for DLD were assessed preoperatively (baseline), 6 weeks (6W) and 3 months (3M) postoperatively. Paired sample t -tests were used to establish significant changes in raw 6-minute walking distance (6WD) and standardized Z-scores, as well as PROMs. Pearson correlation coefficient was used to define the relationship between 6WT and PROMs. Floor and ceiling effects were assessed for each PROM (visual analogue scale [VAS], core outcome measure index [COMI], Zurich claudication questionnaire [ZCQ]). Mean 6WT results improved from 377 m (standard deviation - SD 137; Z-score: 1.8, SD 1.8) to 490 m (SD 126; -0.7, SD 1.5) and 518 m (SD 112; -0.4, SD 1.41; all p<.05) at 6W and 3M follow-up. No significant improvement was observed between 6W and 3M for the ZCQ, VAS back and leg pain. While correlation between 6WT and all PROMs were weak at baseline, correlation coefficient increased to moderate at 3M. A considerable ceiling effect (best possible score) was observed, most notably for the ZCQ physical performance, VAS back and leg pain in 24%, 20%, and 16% of patient at 6W and in 30%, 24%, and 28% at 3M. Objective functional tests can describe the continued change in the physical recovery of a patient and may help to detect differences in well performing groups as well as in cases where patients' PROM results cannot further improve because of a ceiling effect. [ABSTRACT FROM AUTHOR]

Background Context: We lack models that reliably predict 30-day postoperative adverse events (AEs) following spine surgery.Purpose: We externally validated a previously developed predictive model for common 30-day adverse events (AEs) after spine surgery.Study Design/setting: This prospective cohort study utilizes inpatient and outpatient data from a tertiary academic medical center.Patient Sample: We assessed a prospective cohort of all 276 adult patients undergoing spine surgery in the Department of Neurosurgery at a tertiary academic institution between April 1, 2018 and October 31, 2018. No exclusion criteria were applied.Outcome Measures: Incidence of observed AEs was compared with predicted incidence of AEs. Fifteen assessed AEs included: pulmonary complications, congestive heart failure, neurological complications, pneumonia, cardiac dysrhythmia, renal failure, myocardial infarction, wound infection, pulmonary embolus, deep venous thrombosis, wound hematoma, other wound complication, urinary tract infection, delirium, and other infection.Methods: Our group previously developed the Risk Assessment Tool for Adverse Events after Spine Surgery (RAT-Spine), a predictive model of AEs within 30 days following spine surgery using a cohort of approximately one million patients from combined Medicare and MarketScan databases. We applied RAT-Spine to the single academic institution prospective cohort by entering each patient's preoperative medical and demographic characteristics and surgical type. The model generated a patient-specific overall risk score ranging from 0 to 1 representing the probability of occurrence of any AE. The predicted risks are presented as absolute percent risk and divided into low (<17%), medium (17%-28%), and high (>28%).Results: Among the 276 patients followed prospectively, 76 experienced at least one 30-day postoperative AE. Slightly more than half of the cohort were women (53.3%). The median age was slightly lower in the non-AE cohort (63 vs. 66.5 years old). Patients with Medicaid comprised 2.5% of the non-AE cohort and 6.6% of the AE cohort. Spinal fusion was performed in 59.1% of cases, which was comparable across cohorts. There was good agreement between the predicted AE and observed AE rates, Area Under the Curve (AUC) 0.64 (95% CI 0.56-0.710). The incidence of observed AEs in the prospective cohort was 17.8% among the low-risk group, 23.0% in the medium-risk group, and 38.4% in the high risk group (p =.003).Conclusions: We externally validated a model for postoperative AEs following spine surgery (RAT-Spine). The results are presented as low-, moderate-, and high-risk designations. [ABSTRACT FROM AUTHOR]

As the use of machine learning algorithms in the development of clinical prediction models has increased, researchers are becoming more aware of the deleterious effects that stem from the lack of reporting standards. One of the most obvious consequences is the insufficient reproducibility found in current prediction models. In an attempt to characterize methods to improve reproducibility and to allow for better clinical performance, we utilize a previously proposed taxonomy that separates reproducibility into 3 components: technical, statistical, and conceptual reproducibility. By following this framework, we discuss common errors that lead to poor reproducibility, highlight the importance of generalizability when evaluating a ML model's performance, and provide suggestions to optimize generalizability to ensure adequate performance. These efforts are a necessity before such models are applied to patient care. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort studying using a national, administrative database.Objective: The aim of this study was to determine the postoperative complications and quality outcomes of patients with and without obesity undergoing surgical management for lumbar degenerative disease (LDD).Summary Of Background Data: Obesity is a global epidemic that negatively impacts health outcomes. Characterizing the effect of obesity on LDD surgery is important given the growing elderly obese population.Methods: This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether the patient had a concurrent diagnosis of obesity at time of surgery. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between patients with and without obesity. Patients who underwent three or more levels surgical correction, were under the age of 18 years, or those with any previous history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.Results: A total of 67,215 patients underwent primary lumbar degenerative surgery, of which 22,405 (33%) were obese. After propensity score matching, baseline covariates of the two cohorts were similar. The complication rate was 8.3% in the nonobese cohort and 10.4% in the obese cohort (P < 0.0001). Patients with obesity also had longer lengths of stay (2.7 days vs. 2.4 days, P < 0.05), and higher rates of reoperation and readmission at all time-points through the study follow-up period to their nonobese counterparts (P < 0.05). Including payments after discharge, lumbar degenerative surgery in patients with obesity was associated with higher payments throughout the 2-year follow-up period ($68,061 vs. $59,068 P < 0.05).Conclusion: Patients with a diagnosis of obesity at time of LDD surgery are at a higher risk for postoperative complications, reoperation, and readmission.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

To determine postoperative complications and quality outcomes of single-stage and multistage surgical management for lumbar degenerative disease (LDD). This retrospective cohort study using a national administrative database identified patients who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether their surgeon chose to perform single-stage or multistage LDD surgery, and these cohorts were mutually exclusive. Propensity score matching was used to mitigate intergroup differences between single-stage and multistage patients. Patients who underwent ≥3 levels of surgical correction, who were <18 years old, or who had any prior history of trauma or tumor were excluded from the study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined. Primary surgery for LDD was performed in 47,190 patients; 9438 (20%) of these patients underwent multistage surgery. After propensity score matching, baseline covariates of the 2 cohorts were similar. The complication rate was 6.1% in the single-stage cohort and 11.0% in the multistage cohort. Rates of posthemorrhagic anemia, infection, wound complication, deep vein thrombosis, and hematoma all were higher in the multistage cohort. Length of stay, revisions, and readmissions were also significantly higher in the multistage cohort. Through 2 years of follow-up, multistage surgery was associated with higher payments throughout the 2-year follow-up period ($57,036 vs. $39,318, P < 0.05). Single-stage surgery for LDD demonstrated improved outcomes and lower health care utilization. Spine surgeons should carefully consider single-stage surgery when treating patients with LDD requiring <3 levels of correction. [ABSTRACT FROM AUTHOR]

In cases of adult spinal deformity (ASD) with severe sagittal malalignment, the use of osteotomies may be necessary in addition to posterior fusion. However, few data exist describing the impact of osteotomies on complications and quality outcomes during ASD surgery. We queried the MarketScan database to identify patients who underwent ASD surgery in 2007–2016. Patients were stratified according to whether or not an osteotomy was used in the index operation. Propensity score matching was used to mitigate intergroup differences between osteotomy and nonosteotomy groups. Patients <18 years old and patients with any prior history of trauma or tumor were excluded from the study. Of 7423 patients who met the inclusion criteria of this study, 2700 (36.4%) received an osteotomy. After propensity score matching, baseline comorbidities and approach type were similar between cohorts. The overall 90-day complication rate was 43.2% in the nonosteotomy group and 52.8% in the osteotomy group (P < 0.0001). The osteotomy cohort also had significantly higher rates of revision surgeries through 2 years (21.1% vs. 18.0%, P < 0.05) following index surgery. Patients who received a 3-column osteotomy had the highest procedural payments, costing $155,885 through 90 days and $167,161 through 1 year following surgery. This analysis confirms high costs and complication, readmission, and reoperation rates until 2 years after ASD surgery in general, which are even higher in cases where an osteotomy is required. Future research should explore strategies for optimizing patient outcomes following osteotomy. [ABSTRACT FROM AUTHOR]

Background Context: Outpatient postoperative pain management in spine patients, specifically involving the use of opioids, demonstrates significant variability.Purpose: Using preoperative risk factors and 30-day postoperative opioid prescribing patterns, we developed models for predicting long-term opioid use in patients after elective spine surgery.Study Design/setting: This retrospective cohort study utilizes inpatient, outpatient, and pharmaceutical data from MarketScan databases (Truven Health).Patient Sample: In all, 19,317 patients who were newly diagnosed with low back or lower extremity pain (LBP or LEP) between 2008 and 2015 and underwent thoracic or lumbar surgery within 1 year after diagnosis were enrolled. Some patients initiated opioids after diagnosis but all patients were opioid-naïve before the diagnosis.Outcome Measures: Long-term opioid use was defined as filling ≥180 days of opioids within one year after surgery.Methods: Using demographic variables, medical and psychiatric comorbidities, preoperative opioid use, and 30-day postoperative opioid use, we generated seven models on 80% of the dataset and tested the models on the remaining 20%. We used three regression-based models (full logistic regression, stepwise logistic regression, least absolute shrinkage and selection operator), support vector machine, two tree-based models (random forest, stochastic gradient boosting), and time-varying convolutional neural network. Area under the curve (AUC), Brier index, sensitivity, and calibration curves were used to assess the discrimination and calibration of the models.Results: We identified 903 (4.6%) of patients who met criteria for long-term opioid use. The regression-based models demonstrated the highest AUC, ranging from 0.835 to 0.847, and relatively high sensitivities, predicting between 74.9% and 76.5% of the long-term opioid use patients in the test dataset. The three strongest positive predictors of long-term opioid use were high preoperative opioid use (OR 2.70; 95% confidence interval [CI] 2.27-3.22), number of days with active opioid prescription between postoperative days 15 to 30 (OR 1.10; 95%CI 1.07-1.12), and number of dosage increases between postoperative day 15 to 30 (OR 1.71, 95%CI 1.41-2.08). The strongest negative predictors were number of dosage decreases in the 30-day postoperative period.Conclusions: We evaluated several predictive models for postoperative long-term opioid use in a large cohort of patients with LBP or LEP who underwent surgery. A regression-based model with high sensitivity and AUC is provided online to screen patients for high risk of long-term opioid use based on preoperative risk factors and opioid prescription patterns in the first 30 days after surgery. It is hoped that this work will improve identification of patients at high risk of prolonged opioid use and enable early intervention and counseling. [ABSTRACT FROM AUTHOR]

Background: Rates of adverse events following spine surgery vary widely by patient-, diagnosis-, and procedure-related factors. It is critical to understand the expected rates of complications and to be able to implement targeted efforts at limiting these events.Purpose: To develop and evaluate a set of predictive models for common adverse events after spine surgery.Study Design: A retrospective cohort study.Patient Samples: We extracted 345,510 patients from the Truven MarketScan (MKS) and MarketScan Medicaid Databases and 760,724 patients from the Centers for Medicare and Medicaid Services (CMS) Medicare database who underwent spine surgeries between 2009 and 2013.Outcome Measures: Overall adverse event (AE) occurrence and types of AE occurrence during the 30-day postoperative follow-up.Methods: We applied a least absolute shrinkage and selection operator regularization method and a logistic regression approach for predicting the risks of an overall AE and the top six most commonly observed AEs. Predictors included patient demographics, location of the spine procedure, comorbidities, type of surgery performed, and preoperative diagnosis.Results: The median ages of MKS and CMS patients were 49 years and 69, respectively. The most frequent individual AE was a cardiac dysfunction in CMS (10.6%) patients and a pulmonary complication (4.7%) in MKS. The area under the curve (AUC) of a prediction model for an overall AE was 0.7. Among the six individual prediction models, the model for predicting the risk of a pulmonary complication showed the greatest accuracy (AUC 0.76), and the range of AUC for these six models was 0.7 and 0.76. Medicaid status was one of the most important factors in predicting the occurrences of AEs; Medicaid recipients had increased odds of AEs by 20%-60% compared with non-Medicaid patients (odds ratios 1.28-1.6; p<10-10). Logistic regression showed higher AUCs than least absolute shrinkage and selection operator across these different models.Conclusions: We present a set of predictive models for AEs following spine surgery that account for patient-, diagnosis-, and procedure-related factors which can contribute to patient-counseling, accurate risk adjustment, and accurate quality metrics. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective propensity score-matched analysis on a national database (MarketScan) between 2006 and 2010. Objective. To compare rates of neurological deficits after elective single-level spinal procedures with and without intraoperative neuromonitoring, as well as associated payment differences and geographic variance. Summary of Background Data. Intraoperative neurophysiologic monitoring is a technique that may contribute to avoiding permanent neurological injury during some spine surgery procedures. However, it is unclear whether all patients undergoing spine surgery benefit from neuromonitoring. Methods. An identified 85,640 patients underwent single-level spinal procedures including anterior cervical discectomy and fusion (ACDF), lumbar fusion, lumbar laminectomy, or lumbar discectomy. Neuromonitoring was identified with appropriate Current Procedural Terminology (CPT) codes. Cohorts were balanced on baseline comorbidities and procedure characteristics using propensity score matching. Trauma and spinal tumors cases were excluded. Results. Patients (12.66%) received neuromonitoring intraoperatively. Lumbar laminectomies had reduced 30-day neurological complication rate with neuromonitoring (0.0% vs. 1.18%, P = 0.002). Neuromonitoring did not correlate with reduced intraoperative neurological complications in ACDFs (0.09% vs. 0.13%), lumbar fusions (0.32% vs. 0.58%), or lumbar discectomy (1.24% vs. 0.91%). With the addition of neuromonitoring, payments for ACDFs increased 16.24% ($3842), lumbar fusions 7.84% ($3540), lumbar laminectomies 24.33% ($3704), and lumbar discectomies 22.54% ($2859). Significant geographic variation was evident. Some states had no recorded single-level spinal cases with concurrent neuromonitoring. Rates for ACDFs and lumbar fusions, laminectomies, and discectomies ranged as high as 61%, 58%, 22%, and 21%, respectively. Conclusion. With intraoperative neurological monitoring in single-level procedures, neurological complications were decreased only among lumbar laminectomies. No difference was observed in ACDFs, lumbar fusions, or lumbar discectomies. There was a significant increase in total payments associated with the index procedure and hospitalization. We demonstrate significant geographic variation in neuromonitoring. [ABSTRACT FROM AUTHOR]

Abstract: Background context: The Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA grade) are useful for predicting morbidity and mortality for a variety of disease processes. Purpose: To evaluate CCI and ASA grade as predictors of complications after spinal surgery and examine the correlation between these comorbidity indices and the cost of care. Study design/setting: Prospective observational study. Patient sample: All patients undergoing any spine surgery at a single academic tertiary center over a 6-month period. Outcome measures: Direct health-care costs estimated from diagnosis related group and Current Procedural Terminology (CPT) codes. Methods: Demographic data, including all patient comorbidities, procedural data, and all complications, occurring within 30 days of the index procedure were prospectively recorded. Charlson Comorbidity Index was calculated from International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and ASA grades determined from the operative record. Diagnosis related group and CPT codes were captured for each patient. Direct costs were estimated from a societal perspective using Medicare rates of reimbursement. A multivariable analysis was performed to assess the association of the CCI and ASA grade to the rate of complication and direct health-care costs. Results: Two hundred twenty-six cases were analyzed. The average CCI score for the patient cohort was 0.92, and the average ASA grade was 2.65. The CCI and ASA grade were significantly correlated, with Spearman ρ of 0.458 (p<.001). Both CCI and ASA grade were associated with increasing body mass index (p<.01) and increasing patient age (p<.0001). Increasing CCI was associated with an increasing likelihood of occurrence of any complication (p=.0093) and of minor complications (p=.0032). Increasing ASA grade was significantly associated with an increasing likelihood of occurrence of a major complication (p=.0035). Increasing ASA grade showed a significant association with increasing direct costs (p=.0062). Conclusions: American Society of Anesthesiologists and CCI scores are useful comorbidity indices for the spine patient population, although neither was completely predictive of complication occurrence. A spine-specific comorbidity index, based on ICD-9-CM coding that could be easily captured from patient records, and which is predictive of patient likelihood of complications and mortality, would be beneficial in patient counseling and choice of operative intervention. [Copyright &y& Elsevier]

The article offers a clinical prospective observational study to establish the impact of comorbid conditions and preoperative complications in post-spinal surgery patients. It offers the study's demographics, costs of specific complication management and comorbidities. The findings indicate that cost of health care rises with spinal surgery complications and comorbid conditions further the medical expenditure.

Abstract: Background Context: The correlation between obesity and incidence of complications in spine surgery is unclear, with some reports suggesting linear relationships between body mass index (BMI) and complication incidence and others noting no relationship. Purpose: The purpose of this article was to assess the relationship between obesity and occurrence of perioperative complications in an elective thoracolumbar surgery cohort. Study Design/Setting: Prospective observational cohort study at a tertiary care facility. Patient Sample: Cohort of 87 consecutive patients undergoing elective surgery for degenerative thoracolumbar pathologies over a 6-month period (May to December 2008). Outcome Measures: Incidence of perioperative complications (those occurring within 30 days of surgery). Methods: A prospective assessment of perioperative spine surgery complications was completed, and data were prospectively entered into a central database. Two independent auditors assessed for the presence and severity of perioperative complications. Previously validated binary definitions of major and minor complications were used. Patient data and early complications (those occurring within 30 days of index surgery) were analyzed using multivariate regression. Results: Mean BMI in this cohort was 31.3; 40.8% of patients were obese (BMI>30) and 10 patients (11.5%) were morbidly obese (BMI>40). The overall complication incidence was 67%. Minor complications occurred in 50% of patients, and major complications occurred in 17.8% of patients. No positioning palsies occurred in this series. Age correlated with an increase in complication risk (p=.006) as did hypertension (p=.004) and performance of a fusion (p<.0001). BMI did not correlate with the incidence of minor, major, or any complications (p=.58). Conclusions: This prospective assessment of perioperative complications in elective degenerative thoracolumbar procedures shows no relationship between patient BMI and the incidence of perioperative minor or major complications. Specific care in perioperative positioning may limit the risk of perioperative positioning palsies in obese patients. [Copyright &y& Elsevier]

Background: Thoracic and lumbar spine surgical procedures are performed for a variety of pathologies. The literature consists of multiple retrospective reviews examining complication prevalence with the surgical treatment of these disorders. However, there is limited direct examination of perioperative complications through a prospective approach. Of the prospective assessments, the majority focuses on specific surgical procedures or provides a limited assessment of certain spinal implants. Prospective assessments of complication incidence in broad patient populations are limited. This article analyzes a prospectively collected database of patients who underwent a thoracic and/or lumbar spine surgery at a large tertiary care center and the effect of surgical approach (anterior or posterior) on the incidence of early complications. Methods: Data collection was performed prospectively on 128 patients on the neurosurgical spine service at Thomas Jefferson University hospital from May to December 2008. Data on preoperative diagnosis, medical comorbidities, body mass index, surgical approach and procedure, length of stay, and complication occurrence was recorded and analyzed. Acute complications or adverse events occurring within the initial 30 days after each operative procedure were included. All medical adverse events were included as complications. A previously circumstantiated binary definition of major and minor complications was used to stratify the data. Results: Overall, 76 of 128 patients (59.4%) in this cohort experienced at least one complication. Anterior thoracic and lumbar procedures had an 83.3% (5/6) incidence of complications. Of those patients having solely a posterior thoracic and lumbar procedures, 37 of 75 (49.3%) experienced at least one complication. Combined anterior and posterior surgical procedure had a complication incidence of 34 of 47 (72.3%). The mean number of complications reached significance for the minor and overall complications groups (P = .0076 and .0172, respectively, Poisson regression). Comparing the incidence of complications reveals the overall complications in the posterior alone group compared with the anterior/posterior combined group was significantly lower (P = .0134). Those undergoing instrumented fusions were statistically more likely to encounter complications (P<.001). Conclusions: There is a considerably higher complication incidence than previously reported for thoracic, thoracolumbar, and lumbar spine operations. A prospective approach and a broad definition of perioperative complications increased the recorded incidence of perioperative adverse events and complications. The case complexity of a tertiary referral center may also have escalated the increased incidence. Complications were more common in patients undergoing anterior and anterior/posterior procedures. [Copyright &y& Elsevier]