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Mortality After Lumbar Fusion Surgery

Juratli, Sham Maghout MD, MPH*†; Mirza, Sohail K. MD, MPH¶; Fulton-Kehoe, Deborah PhD, MPH∥; Wickizer, Thomas M. PhD**; Franklin, Gary M. MD, MPH‡§

doi: 10.1097/BRS.0b013e31819b2176
Surgery

Study Design. Retrospective population-based cohort study.

Objective. To describe mortality after lumbar fusion surgery in Washington State workers’ compensation claimants in the perioperative period and beyond.

Summary of Background Data. Although lumbar fusion surgery can be associated with serious complications, perioperative mortality is generally considered rare. Population-based mortality estimates have been limited to surgery in older adults.

Methods. We identified all Washington State workers’ compensation claimants who underwent fusion between January 1994 and December 2001 (n = 2378) and assessed the frequency, timing, and causes of death. Mortality follow-up was concluded in 2004. Death was ascertained from Washington State vital statistics records and from the workers’ compensation claims database. Poisson regression was used to obtain age- and gender-adjusted mortality rates. Years of potential life lost, percent of potential life lost, and mean potential life lost were calculated for the leading 5 causes of death and we calculated the risk of death associated with selected predictors.

Results. Among the 2378 lumbar fusion subjects in the study cohort, 103 were deceased by 2004. The 3-year cumulative mortality rate was 1.93% (95% confidence interval, 1.41%–2.57%). The 90-day perioperative mortality rate was 0.29% (95% confidence interval, 0.11%–0.60%). The risk of perioperative mortality was positively associated with repeat fusions. The age- and gender-adjusted all-cause mortality rate was 3.1 deaths per 1000 worker-years (95% confidence interval, 0.9–9.8). Analgesic-related deaths were responsible for 21% of all deaths and 31.4% of all potential life lost. The risk of analgesic-related death was higher among workers who received instrumentation or intervertebral cage devices compared with recipients of bone-only fusions (1.1% vs. 0.0%; P = 0.03) and among workers with degenerative disc disease (age- and gender-adjusted mortality rate ratio, 2.71) (95% confidence interval, 1.17–6.28). The burden was especially high among subjects between 45 and 54 years old with degenerative disc disease (rate ratio, 7.45).

Conclusion. Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent lumbar fusion than any other cause. Risk of analgesic-related death was especially high among young and middle-aged workers with degenerative disc disease.

This is a large population-based cohort study that examines mortality after lumbar fusion surgery among workers with an average follow-up of 6 years. The 90-day perioperative mortality was 0.29%. Analgesic-related death accounted for 21% of all death and 31% of all potential life lost. The risk was higher among workers with degenerative disc disease especially workers aged between 45 to 54 years.

From *Division of Occupational and Environmental Medicine, Wayne State University School of Medicine, Detroit, MI; †Occupational Epidemiology and Health Outcomes Program, University of Washington, Seattle, WA; ‡Department of Environmental and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Seattle, WA; §Washington State Department of Labor and Industries, Olympia, WA; ¶Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon; ∥Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA; and **Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA.

Acknowledgment date: September 2, 2008. Revision date: October 20, 2008. Acceptance date: October 21, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by the Accident and Medical Aid Funds of the State of Washington, Department of Labor and Industries. These research monies are targeted toward reducing the incidence and disability related to occupational injuries and illnesses.

Address correspondence and reprint requests to Sham Maghout Juratli, MD, MPH, 30480 Stonegate Drive, Franklin, MI 48025; E-mail: shamj@u.washington.edu, smjuratli@med.wayne.edu

© 2009 Lippincott Williams & Wilkins, Inc.