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Risk Factors for Medical Complication After Cervical Spine Surgery: A Multivariate Analysis of 582 Patients

Lee, Michael J. MD*; Konodi, Mark A. MS; Cizik, Amy M. MPH*; Weinreich, Mark A. DPT, BS*; Bransford, Richard J. MD; Bellabarba, Carlo MD; Chapman, Jens MD

doi: 10.1097/BRS.0b013e318268ffc9
Cervical Spine

Study Design. Multivariate analysis of prospectively collected registry data.

Objective. Using multivariate analysis to determine significant risk factors for medical complication after cervical spine surgery.

Summary of Background Data. Several studies have examined the occurrence of medical complication after spine surgery. However, many of these studies have been done using large national databases. While these allow for analysis of thousands of patients, potentially influential covariates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question.

Methods. The Spine End Results Registry (2003–2004) is a repository of prospectively collected data on all patients who underwent spine surgery at our 2 institutions. Extensive demographic and medical information was prospectively recorded. Complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. We analyzed risk factors for medical complication after lumbar spine surgery, using univariate and multivariate analyses.

Results. We analyzed data from 582 patients who met our inclusion criteria. The cumulative incidences of complication after cervical spine surgery per organ system are as follows: cardiac, 8.4%; pulmonary, 13%; gastrointestinal, 3.9%; neurological, 7.4%; hematological, 10.8%; and urologic complications, 9.2%. The occurrence of cardiac or respiratory complication after cervical spine surgery was significantly associated with death within 2 years (relative risk, 4.32, 6.43, respectively). Relative risk values with 95% confidence intervals and P values are reported.

Conclusion. Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the cervical spine. Future analyses and models that predict the occurrence of medical complication after cervical spine surgery may be of further benefit for surgical decision making.

Utilizing the Spine End Results Registry, this study performed an exhaustive univariate and multivariate analysis of risk factors for medical complication after cervical spine surgery. The relative risk with 95% confidence intervals and P values were determined for numerous potential risk factors. These data can be beneficial when considering surgical treatment of the cervical spine.

*Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA; and

Department of Orthopedics and Sports Medicine, Harborview Medical Center, Seattle, WA.

Address correspondence and reprint requests to Michael J. Lee, MD, Department of Orthopaedic Surgery Sports Medicine, University of Washington Medical Center, 1959 Pacific Ave. NE, Box 356500, Seattle WA 98195; E-mail: mjl3000@uw.edu

Acknowledgment date: January 31, 2012. First revision date: April 17, 2012. Second revision date: June 21, 2012. Acceptance date: July 2, 2012.

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

NIH/NIAMS 5K23AR48979, 5P60-AR48093, and Spine End-Results Research Fund at the University of Washington Medical Center through a gift from Synthes Spine (Paoli, PA) funds were received to support 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.

© 2013 Lippincott Williams & Wilkins, Inc.