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Adverse events in surgically treated cervical spondylopathic myelopathy: a prospective validated observational study
Dennis Hartig1, Juliet Batke, Nicolas Dea
1*Vancouver General Hospital, Combined Neurosurgical and Orthopaedic Spine Program, Vancouver, Canada †Department of Orthopaedics, Division of Spine, University of British Columbia, Vancouver, Canada; and ‡Orthopaedic Department, Royal Brisbane Hospital, Brisbane, Queensland, Australia.
Study Design:
Prospective observational study.
Objective:
Using validated tools to accurately identify and quantify incidence of and risks for inpatient adverse events (AEs) associated with surgical management of cervical spondylopathic myelopathy (CSM) with the goal of assisting physicians and patients in decision making. To identify patient-/disease-/technique-specific, independent risk factors for developing AEs perioperatively and affecting length of stay for patients treated surgically for CSM.
Summary Of Background Data:
Previous studies have reported an overall perioperative complication rate between 15.6% and 18.52%.
Methods:
A total of 104 patients underwent surgery for CSM in our academic quaternary referral center. The average age was 60.3 years (range, 34-86 yr) with a male preponderance (n = 77, 74%). The severity of myelopathy and significant comorbidities was measured and was in keeping with previously assessed populations. Surgical approach was anterior-alone (39.4%), posterior-alone (55.8%), or combined (4.8%) surgery. Inpatient AE data were collected in a rigorous, contemporaneous fashion using the previously validated Spine Adverse Events Severity System (SAVES) tool.
Results:
A total AE rate of 42.3% was documented in surgically managed patients with CSM (intraoperative = 13.5%, postoperative = 37.5%). Statistically significant risk factors for postoperative AEs were identified, including number of comorbidities (P = 0.012), anterior surgical approach (P = 0.003), and number of levels operated on (P = 0.031). Multiple risk factors for length of stay were also identified, including number of AEs (P < 0.0001), Nurick Score (P < 0.0001), number of levels operated on (P = 0.006), and occurrence of deep wound infection (P < 0.0001).
Conclusion:
We report higher perioperative AE rates than previously recognized, due to the use of a validated, rigorous data collection tool. Multiple novel patient/disease severity/surgical factors with high statistical significance on perioperative AEs have been identified.
Level Of Evidence:
3.
