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Thread: Complications due to fusion surgery - A survey of US Hospitals

  1. #1
    Join Date
    Jan 2008
    Location
    NorthCarolina
    Posts
    51

    Complications due to fusion surgery - A survey of US Hospitals

    I like to read Spine Journal on my lunch hour at work, but it's articles like the one below that motivate me to follow in the foot steps of mom's like Ruth and Melissa and leave absolutely no stone unturned before thinking about surgery for my daughter. Judging from all the surgical revision posts I've read on this forum, 25% complication rate in adults, 14% in children does sound too far fetched.

    Inpatient complications, mortality, and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective.

    Patil CG, Santarelli J, Lad SP, Ho C, Tian W, Boakye M.
    Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive Room R200, MC5327, Stanford, CA 94305, USA.

    BACKGROUND CONTEXT: Information about complications and mortality after surgery for correction of idiopathic scoliosis has been largely derived from single-institution series. Regional or national studies have been lacking. PURPOSE: To report inpatient mortality, complications, and discharge disposition after surgical correction of idiopathic scoliosis on a national level. STUDY DESIGN: Retrospective cohort study using National Inpatient Sample (NIS) administrative data. PATIENT SAMPLE: All patients in the NIS with the primary diagnosis of idiopathic scoliosis who underwent a spinal fusion between 1993 and 2002 were included. OUTCOME MEASURES: Inpatient complication rate, mortality rate, and adverse outcome defined by death or discharge to institution other than home. METHODS: Outcome measures were abstracted from the NIS. Univariate and multivariate analyses were performed to analyze the effects of patient and hospital characteristics on outcome measures. RESULTS: The NIS was used to identify 51,911 patients who underwent spinal fusion for idiopathic scoliosis in the United States from 1993 to 2002. The total inhospital complication rate was 14.9% for pediatric patients and 25.1% for adult patients. The inhospital mortality rate was 0.17% and 0.40% for pediatric and adult patients, respectively. Adverse outcome was noted in 2.3% of pediatric patients and 20.4% of adult patients. Pulmonary and postoperative hemorrhages/hematomas were the most common complications reported. Multivariate analysis for complications showed that morbidity was significantly lower for pediatric patients (odds ratio [OR]=0.80; confidence interval [CI]=0.68-0.94) and female patients (OR=0.77; CI=0.68-0.88). Patients with a preoperative comorbidity were 1.53 (CI=1.32-1.76) times more likely to develop a complication. A single postoperative complication increased the mean length of stay by more than 2 days and increased the mortality rate, adverse outcome, and hospital charges significantly. CONCLUSIONS: We have provided a national perspective on inpatient complications, mortality, and discharge disposition after spinal fusion for idiopathic scoliosis in the United States. The significant negative effects of postoperative complications on mortality and resource utilization have been demonstrated. Furthermore, we have identified adult age, male gender, and preoperative comorbidity as important risk factors and defined their impact on patient outcomes.
    Mom to Haley, 13.5 yrs old
    Diagnosed at 6 yrs old - 18T.
    Boston Brace at 9.5 yrs old - 34T/18L
    Switched to SpineCor at 10 yrs old
    Stable at ~22T OBX until 12.5 yrs old
    Adolescent growth spurt was brutal - scheduled for surgery Dec 7th.

  2. #2
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    Be sure to consider the time period also ...

    "United States from 1993 to 2002".

    During this time, 9 out of 10 ICU keyboards tested postitive for MRSA (I contracted it in 2001). A lot of things have changed - for the better - since then.
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  3. #3
    Join Date
    Jan 2008
    Location
    NorthCarolina
    Posts
    51
    Yes, I absolutely agree it's old data. Hopefully things have changed for the better.

    These are the types of articles you shouldn't read when suffering from PXS (Pre Xray Syndrome). This syndrome typically strikes the week before your daughter's next Dr appointment and can lead to anxiety, paranoia, irritability and non stop staring at your child's back from every possible angle.
    Mom to Haley, 13.5 yrs old
    Diagnosed at 6 yrs old - 18T.
    Boston Brace at 9.5 yrs old - 34T/18L
    Switched to SpineCor at 10 yrs old
    Stable at ~22T OBX until 12.5 yrs old
    Adolescent growth spurt was brutal - scheduled for surgery Dec 7th.

  4. #4
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757

    Pxs

    Quote Originally Posted by HaleyMom
    These are the types of articles you shouldn't read when suffering from PXS (Pre Xray Syndrome). This syndrome typically strikes the week before your daughter's next Dr appointment and can lead to anxiety, paranoia, irritability and non stop staring at your child's back from every possible angle.
    Not a funny topic, I know ... but phrased that way (I'm sorry!), I can't stop laughing ...
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  5. #5
    Join Date
    Jan 2006
    Posts
    513
    PXS..............That is a really good one! Sometimes I have PXS with my PMS.LOL!
    God has used scoliosis to strengthen and mold us. He's good all the time!On this forum these larger curves have not held forever in Spinecor,with an initial positive response followed by deterioration. With deterioration, change treatment.The first year she gained 4 or 5 inches and was stable at around 20/20 in brace, followed by rapid progression the next year.She is now 51/40 (Jan2008)out of brace (40/30 in Spinecor) and started at 38/27 out of brace(Jan2006.) Now in Cheneau.

  6. #6
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    7,187
    Hi HaleyMom...

    Complications during such major surgeries are not uncommon, and should definitely be a factor in making the decision about whether to have surgery or not. I've seen and heard of some really horrid outcomes, and know that if you're one of the unlucky ones, percentages mean nothing. Thankfully, most complications are relatively easy to treat.

    Regards,
    Linda

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