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Updated: Nov 2, 2025
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Published on: February 14, 2025
Incidence and Risk Factors for Early Postoperative Complications and Mortality Following Adult Spinal Deformity
Ho-Joong Kim1,2, Scott L Zuckerman2, Meghan Cerpa2
1Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, Republic of Korea.
Study Design:
Retrospective cohort analysis using the American College of Surgeons National Surgical Quality Improvement Program database.
Objective:
The objective of this study was to investigate the incidence and risk factors of perioperative complications and mortality in patients undergoing adult spinal deformity (ASD) surgery.
Summary Of Background Data:
Although ASD surgery has been associated with a relatively high complication rate, a focus on perioperative complications in a large cohort has rarely been reported.
Materials And Methods:
In the database of the 2011-2013 American College of Surgeons National Surgical Quality Improvement Program database, a cohort of patients (n=1484) above 20 years and underwent ASD surgery was established by primary and other Current Procedural Terminology and International Classification of Disease, Ninth Revision codes. The incidences of perioperative (within 30 d postsurgery) minor/major complications and mortality was investigated. Risk factors for minor/major complications and mortality were assessed using logistic regression modeling.
Results:
Of 1484 patients undergoing ASD surgery, the overall complication rate was 15.8% (minor complications: 8.2%; major complications: 10.4%), and the mortality rate was 0.6% (9 patients). After multivariate analysis, dependent functional status [P=0.003; odds ratios (ORs), 4.838], anterior or anterior+posterior approaches (P=0.001; OR, 2.022), and prolonged operative time (>5 h) (P=0.004; OR, 1.821) were associated with an increased risk of minor complications. Male sex (P=0.013; OR, 1.567), osteotomy procedure (P=0.008; OR, 1.674) and prolonged operative time (>5 h) (P<0.001; OR, 2.142) were associated with an increased risk of major complications. The American Society of Anesthesiologists 4 status (P=0.009; OR, 34.697) was a strong risk factor for mortality.
Conclusions:
After ASD surgery, the rates of minor complications, major complications, and mortality was 8.2%, 10.4%, and 0.6%, respectively. While mortality depended on patient physical status represented by the American Society of Anesthesiologists 4, minor and major complications were associated with male sex, dependent functional status, and surgical factors such as osteotomy procedure, prolonged operative time (>5 h), and having an anterior surgical approach. Therefore, this information may be helpful in surgical counseling and preoperative surgical planning.
