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viernes, 16 de noviembre de 2012

Rates and Causes of Mortality Associated With Spine Surgery Based on 108,419 Procedures

Fuente: http://www.medscape.com/viewarticle/773592



Rates and Causes of Mortality Associated With Spine Surgery Based on 108,419 Procedures

A Review of the Scoliosis Research Society Morbidity and Mortality Database

Justin S. Smith, MD, PhD, Dwight Saulle, MD, Ching-Jen Chen, BA, Lawrence G. Lenke, MD, David W. Polly, Jr, MD, Manish K. Kasliwal, MD, Paul A. Broadstone, MD, Steven D. Glassman, MD, Alexander R. Vaccaro, MD, PhD, Christopher P. Ames, MD, Christopher I. Shaffrey, MD
  Nov 14, 2012Authors & Disclosures
Spine. 2012;37(23):1975-1982. © 2012 Lippincott Williams & Wilkins 

Abstract and Introduction

Abstract

Study Design. A retrospective review of a prospectively collected database.

Objective. To assess rates and causes of mortality associated with spine surgery.

Summary of Background Data. Despite the best of care, all surgical procedures have inherent risks of complications, including mortality. Defining these risks is important for patient counseling and quality improvement.

Methods. The Scoliosis Research Society Morbidity and Mortality database was queried for spinal surgery cases complicated by death from 2004 to 2007, including pediatric (younger than 21 yr) and adult (21 yr or older) patients. Deaths occurring within 60 days and complications within 60 days of surgery that resulted in death were assessed.

Results. A total of 197 mortalities were reported among 108,419 patients (1.8 deaths per 1000 patients). Based on age, rates of death per 1000 patients for adult and pediatric patients were 2.0 and 1.3, respectively. Based on primary diagnosis (available for 107,996 patients), rates of death per 1000 patients were as follows: 0.9 for degenerative (n = 47,393), 1.8 for scoliosis (n = 26,421), 0.9 for spondylolisthesis (n = 11,421), 5.7 for fracture (n = 6706), 4.4 for kyphosis (n = 3600), and 3.3 for other (n = 12,455). The most common causes of mortality included: respiratory/pulmonary causes (n = 83), cardiac causes (n = 41), sepsis (n = 35), stroke (n = 15), and intraoperative blood loss (n = 8). Death occurred prior to hospital discharge for 109 (79%) of 138 deaths for which this information was reported. The specific postoperative day (POD) of death was reported for 94 (48%) patients and included POD 0 (n = 23), POD 1–3 (n = 17), POD 4–14 (n = 30), and POD >14 (n = 24). Increased mortality rates were associated with higher American Society of Anesthesiologists score, spinal fusion, and implants ( P < 0.001). Mortality rates increased with age, ranging from 0.9 per 1000 to 34.3 per 1000 for patients aged 20 to 39 years and 90 years or older, respectively.





Conclusion

Based on 108,419 spine surgery cases from the SRS M&M database, the overall rate of mortality within 60 days of surgery was 1.8 per 1000 patients. This rate was higher for adults than for pediatric patients (2.0 vs. 1.3 per 1000 patients, respectively) and varied on the basis of diagnosis, ranging from 0.9 per 1000 patients with degenerative conditions and spondylolisthesis to 5.7 per 1000 patients with spine fractures. The most common causes of death were respiratory/pulmonary causes, cardiac causes, sepsis, stroke, and intraoperative blood loss. Increased mortality rates were associated with higher ASA score, spinal fusion, and implants ( P < 0.001). Mortality rates increased with age, ranging from 0.9 per 1000 to 34.3 per 1000 for patients aged 20 to 39 years and 90 years or older, respectively. These findings may prove valuable for patient counseling and efforts to improve the safety of patient care.
 

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