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Risk factors for in-hospital mortality after spine surgery: a matched case-control study using a multicenter database
Junichi Kushioka1, Shota Takenaka1, Takahiro Makino1
1Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Summary
Massive intraoperative hemorrhage, preoperative renal comorbidity, and elevated liver enzymes increase in-hospital mortality risk after spine surgery. Patients with dialysis-dependency, infections, or tumors face higher mortality risks than those with degenerative conditions.
Area of Science:
- Spine surgery outcomes research
- Patient safety in surgical procedures
- Epidemiology of surgical complications
Background:
- Identifying preoperative and intraoperative factors influencing mortality after spine surgery remains a critical challenge.
- Understanding these risk factors is essential for improving patient outcomes and surgical safety.
Purpose of the Study:
- To identify preoperative and intraoperative risk factors associated with in-hospital mortality following spine surgery.
- Utilizing a matched case-control study design on a multicenter database to achieve robust findings.
Main Methods:
- A retrospective matched case-control study was conducted using prospectively collected multicenter data.
- Patients who died in-hospital (mortality group) were matched with a control group based on age, sex, spinal disease, and surgical procedure.
- Multivariate logistic regression analysis was employed to determine independent risk factors for in-hospital mortality.
Main Results:
- The overall in-hospital mortality rate was 0.09%.
- Higher mortality rates were observed in patients with dialysis-related spondyloarthropathy, infectious spondylodiscitis, and metastatic spinal tumors compared to degenerative diseases.
- Massive intraoperative hemorrhage (>2 L), preoperative renal comorbidity, and elevated preoperative aspartate aminotransferase levels were identified as significant risk factors.
Conclusions:
- Spine surgery in patients with dialysis-dependency, infectious diseases, or metastatic tumors carries a significantly higher risk of in-hospital mortality.
- Massive intraoperative hemorrhage, preoperative renal comorbidity, and preoperative liver dysfunction (indicated by AST levels) are key independent risk factors for in-hospital mortality in spine surgery patients.
