Comparative safety of simultaneous and staged anterior and posterior spinal surgery

Abstract

Study design: Analysis of population-based national hospital discharge data collected for the Nationwide Inpatient Sample.

Objective: To study perioperative outcomes of circumferential spine surgery performed on either the same or different days of the same hospitalization.

Summary of background data: Circumferential spine fusion surgery has been linked to an increased adjusted risk in perioperative morbidity and mortality compared with procedures involving only 1 site. To minimize these risks, some surgeons elect to perform the 2 components of this procedure in separate sessions during the same hospitalization. The value of this approach is uncertain.

Methods: Data collected between 1998 and 2006 for the Nationwide Inpatient Sample were analyzed. Hospitalizations during which a circumferential noncervical spine fusion was performed were identified. Patients were divided into those who had their anterior and posterior portion performed on the same and those performed on different days of the same hospitalization. The prevalence of patient and health care system-related demographics was evaluated. Frequencies of procedure-related complications and mortality were determined. Multivariate regression models were created to identify whether timing of procedures was associated with an independent increase in risk for adverse events.

Results: We identified a total of 11,265 entries for circumferential spine fusion. Of those, 71.2% (8022) were operated in 1 session. Complications were more frequent among staged- versus same-day surgery patients (28.4% vs. 21.7%, P < 0.0001). The incidence of venous thrombosis and adult respiratory distress syndrome also increased among staged candidates, while the trend toward higher mortality (0.5% vs. 0.4%) did not reach significance. In the regression model, staged circumferential spine fusions were associated with a 29% increase in the odds morbidity and mortality compared with same-day procedures.

Conclusion: Staging circumferential spine surgery procedures during the same hospitalization offers no mortality benefit and may even expose patients to increased morbidity.

Figure 1

Depicted are the rates of mortality and selected adverse events among patients undergoing anterior and posterior spine fusion procedures on the same or different days of their hospitalization. P<0.0001 between groups for DVT, ARDS. P=0.53 for moratility, P=0.07 for PE.