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A sliding scale to predict postoperative complications undergoing posterior spine surgery.

Authors
  • Nagata, Kosei1
  • Shinozaki, Tomohiro2
  • Yamada, Koji3
  • Nakajima, Koji4
  • Nakamoto, Hideki1
  • Yamakawa, Kiyofumi5
  • Matsumoto, Takuya6
  • Tokimura, Fumiaki7
  • Kanai, Hiroyuki8
  • Takeshita, Yujiro9
  • Tajiri, Yasuhito10
  • Abe, Hiroaki4
  • Kato, So1
  • Taniguchi, Yuki1
  • Matsubayashi, Yoshitaka1
  • Oshima, Yasushi1
  • Tanaka, Sakae1
  • Okazaki, Hiroshi4
  • 1 Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, Tokyo, Japan. , (Japan)
  • 2 Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo, Japan. , (Japan)
  • 3 Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan. Electronic address: [email protected] , (Japan)
  • 4 Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan. , (Japan)
  • 5 Department of Orthopaedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. , (Japan)
  • 6 Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. , (Japan)
  • 7 Department of Orthopedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan. , (Japan)
  • 8 Department of Orthopedic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. , (Japan)
  • 9 Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Kanagawa, Japan. , (Japan)
  • 10 Department of Orthopedic Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan. , (Japan)
Type
Published Article
Journal
Journal of Orthopaedic Science
Publisher
Elsevier
Publication Date
Jul 01, 2020
Volume
25
Issue
4
Pages
545–550
Identifiers
DOI: 10.1016/j.jos.2019.06.012
PMID: 31285117
Source
Medline
Language
English
License
Unknown

Abstract

There is a lack of consensus of operative time (OT) and estimated blood loss (EBL) for elderly patients based on the predicted risk of complications after posterior spine surgery. The purpose of this study was to evaluate the effect of age, OT, and EBL on the postoperative complication risk and to develop a simple sliding scale. We explored prospectively collected data of consecutive patients who underwent posterior spine surgery in seven tertiary referral hospitals from November 2013 to May 2016. Age (<70, 70-74, 75-79, 80-84, ≥85 years), OT (<2, 2-<3, 3-<4, 4-<5, ≥5 h), and EBL (<500, 500-<1000, 1000-<1500, 1500-<2000, ≥2000 ml) were categorized ranging from 1 (lowest) to 5 (highest). The association between the crude cumulative categories' number and the incidence of complications was analyzed. We further evaluated the association by re-categorizing the cumulative number into three groups (3-4, 5-10, ≥11). Total of 2416 patients (median age: 70 years old) were enrolled and major complications were observed in 75 (3.1%) patients. Age, OT, and EBL showed similar odds ratio (1.18-1.19) as each category increased. The cumulative categories' number fitted the estimate complication risk (Hosmer-Lemeshow P = 0.87), and statistically significant trend was observed between predicted and actual complication rates (Cochran-Armitage test, P < 0.001). When cumulative categories' numbers were stratified into three groups, significant increasing trend of risk were observed (Mantel-Haenszel P < 0.001). Based on the categorical numbers, we proposed a simple sliding scale. Our data indicated that the risk of postoperative complication was associated with cumulative score based on increased age, OT, and EBL. A simple sliding scale was developed based on these factors, which may be useful to predict complication risk after posterior spine surgery. Copyright © 2019. Published by Elsevier B.V.

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