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Sentinel Events in Lumbar Spine Surgery

Marquez-Lara, Alejandro MD; Nandyala, Sreeharsha V. BA; Hassanzadeh, Hamid MD; Sundberg, Eric MD; Jorgensen, Anton MD; Singh, Kern MD

doi: 10.1097/BRS.0000000000000247

Study Design. Retrospective national database analysis.

Objective. A national population-based database was queried to investigate the incidence and perioperative outcomes associated with sentinel events in lumbar spine surgery.

Summary of Background Data. Sentinel events in lumbar spine surgery can have significant medical, social, economic, and legal implications. The incidence and perioperative outcomes associated with these events have not been well characterized.

Methods. Data from the Nationwide Inpatient Sample was queried from 2002 to 2011. Patients who underwent lumbar spinal surgery were identified. Sentinel events including bowel or peritoneal injury, vascular injury, nerve injury, retention of foreign objects, and wrong-site surgery were identified. Patient demographics, comorbidities (Charlson Comorbidity Index), length of stay, total costs, and perioperative outcomes were assessed. The risk for mortality associated with each sentinel event was calculated using a 95% confidence interval. Statistical analysis was performed with SPSS version 20 and a P value of 0.001 or less denoted significance.

Results. A total of 543,146 lumbar spine surgical procedures were recorded from 2002 to 2011, of which 414 (0.8 per 1000 cases) incurred sentinel events. Wrong-site surgical procedures were the most common sentinel events with an incidence of 0.3 per 1000 cases. The incidences for bowel or peritoneal injury, vascular injury, nerve injury, and retention of foreign objects, were 0.06, 0.2, 0.2, and 0.1 per 1000 cases, respectively. There were no significant differences in the mean age (55.9 vs. 56.0, P = 0.911) or comorbidity burden (2.58 vs. 2.63, P = 0.553) between the 2 cohorts. The sentinel event cohort incurred a longer hospitalization, greater costs, and a greater incidence of in-hospital complications, and mortality. Patients with a bowel or peritoneal injury, vascular injury, and wrong-site surgery demonstrated a greater risk of mortality relative to unaffected patients.

Conclusion. This Nationwide Inpatient Sample analysis demonstrates that sentinel events are associated with a significant increase in hospital resource utilization and worsened postoperative outcomes including death. This study demonstrates the financial and medical burden associated with sentinel events in lumbar spine surgery.

Level of Evidence: 4

In Brief

A large retrospective database analysis of 543,146 lumbar spinal procedures demonstrated an incidence of 0.8 sentinel events per 1000 cases. These events resulted in an increased hospital resource utilization and mortality.

Author Information

From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Associate Professor, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612; E-mail:

Acknowledgment date: November 11, 2013. Revision date: December 30, 2013. Acceptance date: January 16, 2014.

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: board membership, consultancy, royalties.

© 2014 by Lippincott Williams & Wilkins