Incidence and Causes of Death After Cervical or Thoracolumbar Adult Spinal Deformity Surgery

Prospective multicenter study.

To determine the incidence of all-cause mortality after adult spinal deformity surgery.

Patients undergoing adult spinal deformity surgery are often frail and the procedures are invasive. The incidence of all-cause mortality among patients undergoing cervical or thoracolumbar deformity surgery is unclear.

Using two prospective, multicenter databases, we identified patients who underwent surgery for cervical deformity surgery from 2013 to 2020 (n=169) or thoracolumbar deformity from 2008 to 2020 (n=1507). Mortality incidence density was calculated as follows: 100×(number of deaths)/(sum of total years of follow-up for all patients).

Of 169 participants in the cervical group (mean±SD age, 61±10 yr), death occurred in 19 (11%). The mean time to death was 25±19 months. Mortality incidence density was 4.4 deaths per 100 person-years. The 30-day mortality rate was 0.6% (1/169) and the 90-day mortality rate was 1.2% (2/169). The three most common causes of death were arrhythmia/cardiac arrest (16%), congestive heart failure (11%), and pneumonia (11%). There were no intraoperative deaths. Of 1507 participants in the thoracolumbar group (mean±SD age, 61±14 yr), death occurred in 53 (3.5%). The mean time to death was 32.5±21.5 months. Mean duration of follow-up was 1.8±1.5 years. The mortality incidence density was 0.8 deaths per 100 person-years. The 30-day mortality rate was 0.1% (1/1507) and 90-day mortality rate was 0.3% (4/1507). The three most common causes of death were nonspine malignancy (13%), pneumonia (9%), and arrhythmia/cardiac arrest (6%).

The number of deaths per year was higher among cervical deformity patients (4.4 per 100 person-years) than among thoracolumbar deformity patients (0.8 per 100 person-years). Pneumonia and arrhythmia/cardiac arrest were among the most common causes of death in both groups.

Level III.