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Early Postoperative Adverse Events Following Multi-Level Posterior Segmental Spinal Instrumentation: A
Shahabeddin Yazdanpanah1, Amy Huang2, Andrew Kim2
1College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA.
Background:
Multi-level posterior segmental spinal instrumentation procedures have increased considerably in recent decades; however, short-term findings remain incompletely generalized. Therefore, this study investigates 30-day outcomes following these procedures to better highlight profiles and associations.
Methods:
The ACS-NSQIP database (2014-2023) was queried for patients undergoing multi-level posterior segmental instrumentation. Cases with missing variables or select complexity-increasing add-ons were excluded. A composite any adverse event (AAE) variable was examined, alongside various other complication subgroupings. Statistics included descriptive transformations, multivariable logistic regressions, and threshold analyses, where appropriate.
Results:
A total of 1348 patients were included (mean age = 60 ± 14; body mass index = 31 ± 7 kg/m2; 49% male; 83% medium-length constructs [3-6 levels]; 14% long [7-12]; 3% very long [13+]). AAE occurred in 24%: major in 21%, minor in 5%, and infection-related in 5%. Age (odds ratio [OR] = 1.019), male sex (OR = 0.694), disseminated cancer (OR = 2.628), admission-to-operation interval (OR = 1.033), and operative time (OR = 1.005) were independently associated with AAE (all P < 0.05). Relative to medium constructs, long (OR = 2.081) and very long (OR = 6.981) fixations showed progressively greater AAE odds (all P < 0.05). Threshold analysis identified an admission-to-operation cutoff of 1 day (76th percentile), with AAE rate increasing from 20% below to 34% above (Benjamini-Hochberg corrected P < 0.001). Similarly, operative time greater than 286 minutes (73rd percentile) corresponded to increased AAE odds (corrected P < 0.001), rising from 16% below to 42% above.
Conclusions:
In this decade-spanning analysis, multi-level posterior segmental spinal instrumentations demonstrated meaningful short-term complication rates. Targeted preoperative counseling and facilitation of timely operative intervention may be warranted, and future studies should further evaluate these associations.
