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abstract
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AIMS
The aim of this study was to identify the risk factors for adverse
events following the surgical correction of cervical spinal
deformities in adults.
METHODS
We identified adult patients who underwent corrective cervical
spinal surgery between 1 January 2007 and 31 December 2015 from the
MarketScan database. The baseline comorbidities and characteristics
of the operation were recorded. Adverse events were defined as the
development of a complication, an unanticipated deleterious
postoperative event, or further surgery. Patients aged < 18 years
and those with a previous history of tumour or trauma were excluded
from the study.
RESULTS
A total of 13,549 adults in the database underwent primary
corrective surgery for a cervical spinal deformity during the study
period. A total of 3,785 (27.9%) had a complication within 90 days
of the procedure, and 3,893 (28.7%) required further surgery within
two years. In multivariate analysis, male sex (odds ratio (OR) 0.90
(95% confidence interval (CI) 0.8 to 0.9); p = 0.019) and a
posterior approach (compared with a combined surgical approach, OR
0.66 (95% CI 0.5 to 0.8); p < 0.001) significantly decreased the
risk of complications. Osteoporosis (OR 1.41 (95% CI 1.3 to 1.6); p
< 0.001), dyspnoea (OR 1.48 (95% CI 1.3 to 1.6); p < 0.001),
cerebrovascular accident (OR 1.81 (95% CI 1.6 to 2.0); p <
0.001), a posterior approach (compared with an anterior approach, OR
1.23 (95% CI 1.1 to 1.4); p < 0.001), and the use of bone
morphogenic protein (BMP) (OR 1.22 (95% CI 1.1 to 1.4); p = 0.003)
significantly increased the risks of 90-day complications. In
multivariate regression analysis, preoperative dyspnoea (OR 1.50
(95% CI 1.3 to 1.7); p < 0.001), a posterior approach (compared
with an anterior approach, OR 2.80 (95% CI 2.4 to 3.2; p <
0.001), and postoperative dysphagia (OR 2.50 (95% CI 1.8 to 3.4); p
< 0.001) were associated with a significantly increased risk of
further surgery two years postoperatively. A posterior approach
(compared with a combined approach, OR 0.32 (95% CI 0.3 to 0.4); p
< 0.001), the use of BMP (OR 0.48 (95% CI 0.4 to 0.5); p <
0.001) were associated with a significantly decreased risk of
further surgery at this time.
CONCLUSION
The surgical approach and intraoperative use of BMP strongly
influence the risk of further surgery, whereas the comorbidity
burden and the characteristics of the operation influence the rates
of early complications in adult patients undergoing corrective
cervical spinal surgery. These data may aid surgeons in patient
selection and surgical planning. Cite this article:
2021;103-B(4):734-738.
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citation
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Varshneya K, Jokhai R, Medress Z A, Stienen M N, Ho A, Fatemi P,
Ratliff J K, Veeravagu A. Factors which predict adverse events
following surgery in adults with cervical spinal deformity. Bone
Joint J 2021; 103-B:734-738.
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