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Assessment of Postoperative Outcomes of Spine Fusion Patients With History of Cardiac Disease
Waleed Ahmad1, Laviel Fernandez, Joshua Bell
1From the Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, New York (Ahmad, Fernandez, Krol, Kummer, Passfall, Naessig, Pierce, Treitakov, Moattari, Joujon-Roche, Williamson, Imbo, and Passias), the Department of Orthopedics, University of Virginia School of Medicine, Charlottesville, VA (Bell and Hassanzadeh), the Department of Orthopedics, UT Southwestern Medical Center, Dallas, TX (Vira), the Department of Orthopedics, Hospital for Special Surgery, New York, New York (Lafage), the Department of Orthopedics, SUNY Downstate Medical Center, Brooklyn, New, York (Paulino and Diebo), and the Department of Orthopedics, Harvard Medical School, Boston, MA (Schoenfeld).
Insights
Elective spine fusion patients with congestive heart failure (CHF) face higher risks of complications and death. Understanding cardiac diagnoses like CHF, coronary artery disease (CAD), and valve disorders is crucial for managing risks in these patients.
Area of Science:
- Cardiology
- Neurosurgery
- Health Services Research
Background:
- Cardiac diagnoses present unique challenges and risks for patients undergoing elective spine fusion.
- Limited data exists on the specific impact of various cardiac conditions on outcomes in this patient population.
Purpose of the Study:
- To investigate the association between different cardiac diagnoses and postoperative outcomes in patients undergoing elective spine fusion surgery.
- To identify specific cardiac conditions that predict increased morbidity and mortality in this surgical cohort.
Main Methods:
- A retrospective analysis of 537,252 patients undergoing elective spine fusion was conducted using the PearlDiver database.
- Patients were stratified into five groups: coronary artery disease (CAD), congestive heart failure (CHF), valve disorder, dysrhythmia, and a control group with no heart disease.
- Outcomes including comorbidities, length of stay, complications, and hospital charges were compared across groups using chi-squared and independent samples t-tests.
Main Results:
- Congestive heart failure (CHF) was associated with significantly higher rates of morbid obesity, peripheral vascular disease, and chronic kidney disease.
- Patients with CHF had increased odds of pneumonia, cerebrovascular accident (CVA), myocardial infarction, sepsis, and death (OR: 2.0 [1.1 to 3.5], P = 0.022).
- Coronary artery disease (CAD) increased the odds of myocardial infarction (OR: 1.64 [1.27 to 2.11]), valve disorders increased CVA risk (OR: 1.4 [1.1 to 1.7]), and dysrhythmia increased CVA risk (OR: 1.8 [1.4 to 2.3]).
Conclusions:
- Pre-existing cardiac conditions significantly impact outcomes following elective spine fusion.
- Congestive heart failure is a major predictor of mortality and severe complications in these patients.
- Risk stratification based on cardiac diagnosis is essential for optimizing perioperative care and minimizing complications in elective spine fusion surgery.
Introduction:
There is paucity on the effect of different cardiac diagnoses on outcomes in elective spine fusion patients.
Methods:
Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having a previous history of coronary artery disease (CAD), congestive heart failure (CHF), valve disorder (valve), dysrhythmia, and no heart disease (control). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, length of stay, complication outcomes, and total hospital charges among the cohort.
Results:
In total, 537,252 elective spine fusion patients were stratified into five groups: CAD, CHF, valve, dysrhythmia, and control. Among the cohort, patients with CHF had significantly higher rates of morbid obesity, peripheral vascular disease, and chronic kidney disease (P < 0.001 for all). Patients with CAD had significantly higher rates of chronic obstructive pulmonary disease, diabetes, hypertension, and hyperlipidemia (all P < 0.001). Comparing postoperative outcomes for CAD and control subjects, CAD was associated with higher odds of myocardial infarction (odds ratio [OR]: 1.64 [1.27 to 2.11]) (P < 0.05). Assessing postoperative outcomes for CHF versus control subjects, patients with CHF had higher rates of pneumonia, cerebrovascular accident (CVA), myocardial infarction, sepsis, and death (P < 0.001). Compared with control subjects, CHF was a significant predictor of death in spine fusion patients (OR: 2.0 [1.1 to 3.5], P = 0.022). Patients with valve disorder compared with control displayed significantly higher rates of 30-day readmission (P < 0.05) and 1.38× greater odds of CVA by 90 days postoperatively (OR: 1.4 [1.1 to 1.7], P = 0.007). Patients with dysrhythmia were associated with significantly higher odds of CVA (OR: 1.8 [1.4 to 2.3], P < 0.001) by 30 days postoperatively.
Conclusion:
Heart disease presents an additional challenge to spine fusion patients who are undergoing a challenging and risky procedure. Before surgical intervention, a proper understanding of cardiac diagnoses could give insight into the potential risks for each patient based on their heart condition and preventive measures showing benefit in minimizing perioperative complications after elective spine fusion.
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