Institutional members access full text with Ovid®

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

Smith, Justin S. MD, PhD*; Saulle, Dwight MD*; Chen, Ching-Jen BA*; Lenke, Lawrence G. MD; Polly, David W. Jr MD; Kasliwal, Manish K. MD*; Broadstone, Paul A. MD§; Glassman, Steven D. MD; Vaccaro, Alexander R. MD, PhD; Ames, Christopher P. MD**; Shaffrey, Christopher I. MD*

doi: 10.1097/BRS.0b013e318257fada
Surgery

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. This study provides rates and causes of mortality associated with spine surgery for a broad range of diagnoses and includes assessments for adult and pediatric patients. These findings may prove valuable for patient counseling and efforts to improve the safety of patient care.

This study provides rates and causes of mortality associated with spine surgery for a broad range of diagnoses based on 108,419 adult and pediatric patients from the Scoliosis Research Society membership. These findings may prove valuable for patient counseling and efforts to improve the safety of patient care.

*Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA

Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO

Departments of Orthopedic Surgery and Neurosurgery, University of Minnesota, Minneapolis, MN

§Spine Surgery Associates, Chattanooga, TN

Leatherman Spine Center, Louisville, KY

Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA

**Department of Neurosurgery, University of California San Francisco, San Francisco, CA.

Address correspondence and reprint requests to Christopher I. Shaffrey, MD, Department of Neurosurgery, University of Virginia Medical Center, PO Box 800212, Charlottesville, VA 22908; E-mail: cis8z@virgina.edu

Acknowledgment date: January 12, 2012. First revision date: February 26, 2012. Acceptance date: March 29, 2012.

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

No funds were received in support of this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.