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Comparative Analysis of Patients With Cauda Equina Syndrome Versus an Unaffected Population Undergoing Spinal Surgery

Marascalchi, Bryan J. BS*; Passias, Peter G. MD*; Goz, Vadim BA*; Weinreb, Jeffrey H. BS*; Joo, LiJin MA; Errico, Thomas J. MD*

doi: 10.1097/BRS.0000000000000170
Epidemiology

Study Design. Retrospective analysis.

Objective. To determine patient demographics, incidence of comorbidities, and procedure-related complications and identify risk factors associated with morbidity and mortality after spinal surgery for cauda equina syndrome (CES).

Summary of Background Data. To our knowledge, no study has provided nationwide estimates of patient characteristics and procedure-related complication rates after spinal surgery for CES relative to an unaffected population.

Methods. Nationwide Inpatient Sample data collected between 2001 and 2010 were analyzed. Discharges with procedural codes for lumbar spinal fusion, decompression, or discectomy were included. The CES cohort included diagnoses of CES, and the unaffected cohort included lumbar spinal pathology diagnoses. Patient demographics, incidence of comorbidities and procedure-related complications, and risk factors associated with morbidity and mortality were compared.

Results. Discharges for 11,207 CES and 689,799 unaffected patients were identified. Differences between cohorts were found for demographic and hospital data. Average comorbidity indices for the CES cohort were found to be increased (0.23 vs. 0.13, P < 0.0001), as well as the incidence of total procedure-related complications (18.63% vs. 13.12%, P < 0.0001). In-hospital mortality rate was significantly increased for the CES cohort (0.30% vs. 0.08%, P < 0.0001). A number of comorbidities associated with additional risk for morbidity and mortality among the CES cohort were identified.

Conclusion. Relative to an unaffected population undergoing similar treatment, patients with CES were more likely to have increased associated comorbidities on presentation, as well as increased complication rates with a prolonged hospital course postoperatively. CES was found to carry an increased incidence of procedure-related complications as well as in-hospital mortality. A number of comorbidities associated with additional risk for morbidity and mortality among the CES cohort were identified. This study provides clinically useful data for surgeons to educate patients at risk for morbidity and mortality as well as direct future research to improve patient outcomes.

Level of Evidence: 3

We statistically compared patient characteristics, procedure-related complications, and risk factors for morbidity and mortality after spinal surgery for cauda equina syndrome (CES) relative to an unaffected population. CES showed an increased incidence of procedure-related complications. This study may help surgeons identify patients at risk and direct future research to improve perioperative outcomes.

*Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, NY; and

Department of Population Health, NYU School of Medicine, Biostatistics, New York, NY.

Address correspondence and reprint requests to Peter G. Passias, MD, Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, 301 E 17th St., New York, NY 10003; E-mail: peter.passias@nyumc.org

Acknowledgment date: September 11, 2013. Revision date: November 10, 2013. Acceptance date: December 9, 2013.

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: employment, grants, payment for lecture, royalties, stocks, travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins