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Indicators help predict back surgery complications, study finds

Saturday September 14, 2013
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For older adults undergoing surgery for spinal stenosis, some simple indicators — age, a poor preoperative health score, extensive surgery and use of insulin or steroids — can predict a high risk of major medical complications, according to a study.

In combination, these risk factors may help clinicians identify patients at increased risk of myocardial infarction and other serious events after spinal stenosis surgery, according to Richard A. Deyo, MD, and colleagues of Oregon Health and Science University in Portland. Spinal stenosis causes back pain, leg pain and other symptoms, and is the most common reason for spine surgery in older adults.

“These factors may help in selecting patients and planning procedures, improving patient safety,” according to the study, which was published in the Sept. 1 issue of Spine.

For the study, the researchers analyzed data on 12,154 patients who underwent surgery for lumbar spinal stenosis at Veterans Affairs medical centers between 1998 and 2009. The data were from the Veterans Affairs National Surgical Quality Improvement Program. Their analysis focused on identifying risk factors for major medical complications such as acute myocardial infarction, stroke, pulmonary embolism, pneumonia, sepsis, coma or cardiac arrest.

The overall rate of such major medical complications was 2.1%, along with a 0.6% risk of death within 90 days. By comparison, the rate of surgical wound-related complications was 3.2%.

Risk of major medical complications increased steadily with age: from less than 1% for patients younger than 50 to 4% for those 80 and older. The risk of wound complications was similar for all age groups.

Another key risk factor was the American Society of Anesthesiologists class — a standard score for assessing patients’ fitness for surgery. After adjustment for other factors, risk of major medical problems was three times higher for patients in ASA class 4 (indicating some type of serious medical condition) versus class 1 (no or mild disease).

More extensive surgery for spinal stenosis also was a significant risk factor. Major medical complications were three times more likely for patients undergoing surgery with spinal fusion, compared with less-extensive spinal decompression procedures.

Risk also was increased for patients using certain medications for chronic diseases such as insulin treatment for diabetes or long-term corticosteroid use for conditions such as chronic lung disease. Lower preoperative functional status also was a risk factor for major medical complications.

Deyo and colleagues created a model incorporating these factors to help identify patients at high risk of major medical complications. Their model showed “moderate” predictive value, which is similar to some other common medical tests and exams.

The authors noted some limitations of their study — including the use of VA patient population, which was almost exclusively male and had a high rate of additional health problems.

Study abstract: http://bit.ly/17Oh68g


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