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Complication Rates of Three Common Spine Procedures and Rates of Thromboembolism Following Spine Surgery Based on 108,419 Procedures: A Report From the Scoliosis Research Society Morbidity and Mortality Committee

Smith, Justin S., MD, PhD*; Fu, Kai-Ming G., MD, PhD*; Polly, David W. Jr., MD; Sansur, Charles A., MD, MHSc; Berven, Sigurd H., MD§; Broadstone, Paul A., MD; Choma, Theodore J., MD; Goytan, Michael J., MD**; Noordeen, Hilali H., MD††; Knapp, Dennis Raymond Jr., MD‡‡; Hart, Robert A., MD§§; Donaldson, William F. III, MD¶¶; Perra, Joseph H., MD∥∥; Boachie-Adjei, Oheneba, MD***; Shaffrey, Christopher I., MD*

doi: 10.1097/BRS.0b013e3181cbc8e7
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Study Design. Retrospective review of a prospectively collected database.

Objective. The Scoliosis Research Society (SRS) collects morbidity and mortality (M and M) data from its members. Our objectives were to assess complication rates for 3 common spine procedures, compare these results with prior literature as a means of validating the database, and to assess rates of pulmonary embolism (PE) and deep venous thrombosis (DVT) in all cases reported to the SRS over 4 years.

Summary of Background Data. Few modern series document complication rates of spinal surgery as routinely practiced across academic and community settings. Those available are typically based on relatively low numbers of procedures or confined to single-surgeon experiences.

Methods. The SRS M and M database was queried for lumbar microdiscectomy (LD), anterior cervical discectomy and fusion (ACDF), and lumbar stenosis decompression (LSD) cases from 2004 to 2007. Revisions were excluded. The database was also queried for occurrence of clinically evident PE and DVT in all cases from 2004 to 2007.

Results. A total of 9692 LDs, 6735 ACDFs, and 10,329 LSDs were identified, with overall complication rates of 3.6%, 2.4%, and 7.0%, respectively. These rates are comparable to previously published smaller series. For assessment of PE and DVT, 108,419 cases were identified and rates were calculated per 1000 cases based on diagnosis, age group, and implant use. Overall rates of PE, death due to PE, and DVT were 1.38, 0.34, and 1.18, respectively. Among 82,082 adults, the rate of PE ranged from 0.47 for LD to 12.4 for metastatic tumor. Similar variations were noted for DVT and deaths due to PE.

Conclusion. Overall major complication rates for LD, ACDF, and LSD based on the SRS M and M database are comparable to those in previously reported smaller series, supporting the validity of this database for study of other less common spinal disorders. In addition, our data provide general benchmarks of clinically evident PE and DVT rates as a basis for ongoing efforts to improve care.

We present complication rates for 3 common spine procedures based on the Scoliosis Research Society morbidity and mortality database. These rates are comparable to those in previously reported smaller series, supporting the validity of this database for study of other less common spinal disorders. In addition, we provide general benchmarks of clinically evident pulmonary embolism and deep venous thrombosis rates as a basis for ongoing efforts to improve care.

From the *Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA; †Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN; ‡Department of Neurosurgery, University of Maryland, Baltimore, MD; §Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, CA; ¶Spine Surgery Associates, Chattanooga, TN; ∥Department of Orthopedic Surgery, University of Missouri, Columbia, MO; **Health Sciences Centre, Winnipeg, MB, Canada; ††The Royal National Orthopedic Hospital, the Great Ormond Street Children's Hospital, London, United Kingdom; ‡‡Orlando Health, Orlando, FL; §§Department of Orthopedic Surgery, Oregon Health & Science University, Portland, OR; ¶¶Department of Orthopedic Surgery, University of Pittsburgh Physicians, Pittsburgh, PA; ∥∥Twin Cities Spine Center, Minneapolis, MN; and ***Hospital for Special Surgery, New York, NY.

Acknowledgment date: September 17, 2009. Revision date: October 19, 2009. Acceptance date: October 20, 2009.

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.

This project was submitted to the Hospital for Special Surgery (New York, NY) Institutional Review Board (IRB) and was determined to be exempt from IRB approval based on the use of de-identified data (IRB number 29045).

Address correspondence and reprint requests to Christopher I. Shaffrey, MD, Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908; E-mail: CIS8Z@hscmail.mcc.virginia.edu

© 2010 Lippincott Williams & Wilkins, Inc.