Introduction: Perioperative complication rates for adult spinal deformity (ASD) have been reported as high as 80%. Reported risk factors include age, co‐morbidifies, and blood loss. While risk scores exist in other surgical disciplines, a system is lacking for ASD. The goal of the study is to identify major peri‐operative complications and determine if patient profiles can be defined in the setting of ASD surgery
Methods: Retrospective, consecutive, multi‐center (n=8) review of major peri‐operative (<6wks post‐op) complications in ASD patients (documented coronal or sagittal deformity). Major complications were identified and categorized as: pulmonary, neurological, cardiovascular, gastrointestinal, and infectious. Clinical chart reviews were conducted to obtain; ASA grade, co‐morbidities, preoperative lab values, and intra/post‐operative parameters. Incidence of complications and patient profiles were described.
Results: 72 patients (18M, 54F) were identified in a review of 953 consecutive ASD patients. Mean age was 54yo (18–79) with a total incidence of 99 major and 133 minor complications. Mean operative time was 491 mn, mean EBL was 2440ml and mean transfusion was 3100ml RBC's. 54% were revision cases (mean 1.9 previous surgeries) and 50% were staged procedures. 44% of patients were ASA grade III (mean ASA 2.33). There was a mean co‐morbidity rate of 2.5 per patient. Most common comorbidities were hypertension, depression/anxiety, coronary artery disease and hypothyroidism. The mean length of ICU stay was 3.4 days. Most common major complications included excessive (>4L) intraoperative bleeding (n=11), return to the OR for deep wound infections (n=11) and pulmonary embolus (n=10)
Conclusion: The inherent risk in ASD surgery may not be avoidable. An improved understanding of risk profiles in patients and procedure‐related parameters is critical. Such information can assist in pre‐operative risk‐benefit decisions and pre‐emptive approaches to reduce risk. This study reveals that patients affected by major complications in ASD surgery may not be ‘typical' high risk patients. This study will form the basis for a prospective multi‐center study and aid in the development of a risk scoring system for ASD (RSSS=RS3)