Related Experiment Video
Updated: Jul 8, 2025
Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
Risk of spinal surgery among individuals who have been re-vascularized for coronary artery disease
Peter G Passias1, Waleed Ahmad1, Bhaveen H Kapadia1
1Department of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA.
Insights
Coronary artery bypass graft (CABG) surgery is superior to stenting for reducing post-operative complications in spine fusion patients. Stenting did not significantly minimize cardiac event risk compared to CABG.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Medical Interventions
Background:
- Patients undergoing elective spine fusion surgery face potential post-operative complications.
- Previous cardiac interventions like coronary artery bypass graft (CABG) and vascular stenting (Stent) may influence these outcomes.
- Understanding the comparative effectiveness of these interventions is crucial for patient risk stratification.
Purpose of the Study:
- To evaluate the impact of prior CABG and Stent procedures on 30-day and 90-day post-operative complications in patients undergoing elective spine fusion.
- To determine if revascularization strategies influence the risk of cardiac events post-spine surgery.
Main Methods:
- A retrospective analysis of 731,173 patients undergoing elective spine fusion from the PearlDiver database.
- Patients were stratified into three groups: prior CABG, prior Stent, and no prior cardiac procedure (No-HP).
- Demographic, diagnostic, and comorbidity data were compared, and binary logistic regression assessed the odds of post-operative complications.
Main Results:
- CABG patients exhibited higher rates of obesity, chronic kidney disease, and diabetes compared to Stent and No-HP groups.
- Stent patients had higher rates of peripheral vascular disease, hypertension, and hyperlipidemia.
- Both CABG and Stent groups had significantly higher 30-day post-operative complication rates (pneumonia, CVA, MI, sepsis, death) compared to No-HP. Stent patients had higher odds of myocardial infarction (MI) compared to CABG patients within 30 and 90 days post-surgery.
Conclusions:
- Coronary artery bypass graft (CABG) remains the preferred intervention for reducing post-operative risks in spine surgery patients.
- Vascular stenting does not offer the same degree of risk reduction for post-procedure cardiac events as CABG.
Hypothesis:
Revascularization is a more effective intervention to reduce future postop complications.
Methods:
Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having previous history of vascular stenting (Stent), coronary artery bypass graft (CABG), and no previous heart procedure (No-HP). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, and comorbidities. Binary logistic regression assessed the odds of 30-day and 90-day postoperative (postop) complications associated with each heart procedure (Odds Ratio [95 % confidence interval]). Statistical significance was set p < 0.05.
Results:
731,173 elective spine fusion patients included. Overall, 8,401 pts underwent a CABG, 24,037 pts Stent, and 698,735 had No-HP prior to spine fusion surgery. Compared to Stent and No-HP patients, CABG patients had higher rates of morbid obesity, chronic kidney disease, and diabetes (p < 0.001 for all). Meanwhile, stent patients had higher rates of PVD, hypertension, and hyperlipidemia (all p < 0.001). 30-days post-op, CABG patients had significantly higher complication rates including pneumonia, CVA, MI, sepsis, and death compared to No-HP (all p < 0.001). Stent patients vs. No-HF had higher 30-day post-op complication rates including pneumonia, CVA, MI, sepsis, and death. Furthermore, adjusting for age, comorbidities, and sex Stent was significantly predictive of a MI 30-days post-op (OR: 1.90 [1.53-2.34], P < 0.001). Additionally, controlling for levels fused, stent patients compared to CABG patients had 1.99x greater odds of a MI within 30-days (OR: 1.99 [1.26-3.31], p = 0.005) and 2.02x odds within 90-days postop (OR: 2.2 [1.53-2.71, p < 0.001).
Conclusion:
With regards to spine surgery, coronary artery bypass graft remains the gold standard for risk reduction. Stenting does not appear to minimize risk of experiencing a post-procedure cardiac event as dramatically as CABG.
More Related Videos
14:14Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
04:33Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review
Published on: November 8, 2024
