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Thread: Study of complications based on 3,552,873(!) spinal fusions

  1. #1
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    Study of complications based on 3,552,873(!) spinal fusions

    Perioperative Complications and Mortality After Spinal Fusions: Analysis of Trends and Risk Factors

    Goz, Vadim; Weinreb, Jeffrey H; McCarthy, Ian; Schwab, Frank; Lafage, Virginie; Errico, Thomas J

    Spine., POST ACCEPTANCE, 7 August 2013

    Abstract:

    Study Design. Retrospective review.

    Objective. To analyze the trends in complications and mortality after spinal fusions.

    Summary of Background Data. Utilization of spinal fusions has been increasing over the past decade. It is essential to evaluate surgical outcomes in order to better identify patients who benefit most from surgical intervention. Integration of empiric evidence from large administrative databases into clinical decision-making is instrumental in providing higher quality, evidence based, patient centered care.

    Methods. This study used nationwide inpatient sample (NIS) data from 2001 through 2010. Patients that underwent spinal fusions were identified using the Clinical Classification Software (CCS) and ICD-9 codes. Data on patient comorbidities, primary diagnosis, and postoperative complications was obtained via ICD-9 diagnosis codes and via CCS categories. National estimates were calculated using weights provided as part of the database. Time trend analysis for average length of stay, total charges, mortality, and comorbidity burden was performed. Univariate and multivariate models were constructed to identify predictors of mortality and postoperative complications.

    Results. An estimated 3,552,873 spinal fusions were performed in the US between 2001 and 2010. The national bill for spinal fusions increased from $10 billion to $46.8 billion. Patients today are older and have a greater comorbidity burden than ten years ago. Mortality remained relatively constant at .46%, 1.2%, and .14% for cervical, thoracic, and lumbar fusions respectively. Morbidity rates showed an increasing trend at all levels. Multivariate analysis of 19 procedure and patient related risk factors and 9 perioperative complications identified 85 statistically significant (p<.01) interactions.

    Conclusion. The data on perioperative risks and risk factors for postoperative complications of spinal fusions presented in this study is pivotal to appropriate surgical patient selection and well-informed risk benefit evaluation of surgical intervention.

    (C) 2013 by Lippincott Williams & Wilkins
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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  2. #2
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    Unfortunately, I think this really only addresses peri-operative, early post-operative, and long-term complications that require additional hospitalization. There are a lot of medical complications that can occur, for which people choose not to treat. (As an example, I ended up with lymphedema. That is something that is not recorded anywhere as a complication from my spine surgery.)

    We have a good grasp of the complications that can occur in surgery. However, I think that, in general, we don't have a good grasp of all the potential medical complications.

    --Linda
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    Thanks for pointing that out, Linda. It's an important distinction. I'm guessing the complications that don't require re-hospitalization outnumber those that do by a long shot.

    I am just blown away by the "n" in this study. I will be posting this the next time someone posts yet another PT or brace study with a handful of subjects and claims it shows something. More is know about surgery than PT and bracing combined because of the huge numbers of subjects for the former.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #4
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    The data is compiled from payer information.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  5. #5
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    Quote Originally Posted by LindaRacine View Post
    The data is compiled from payer information.
    Hey Linda, then these cannot all be scoliosis fusions, yes? That seems like too many. I think this must largely be from all the questionable lumbar fusions for pain which has been cited as the most overused/unnecessary surgery out there AFAIK.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  6. #6
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    Looks like it's all spinal fusions 2001-2010.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

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